Prevalence, awareness, treatment and control of hypertension in Nepal

Mehata, Suresh; Shrestha, Nipun; Mehta, Ranju Kumari; Vaidya, Abhinav; Rawal, Lal; Bhattarai, Navaraj; Mishra, Shiva Raj

doi:10.1097/hjh.0000000000001745

Cited by 33 publications

(15 citation statements)

References 23 publications

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“…Excluding aged 15–29 years, the prevalence stood around 26.7% which is comparable with the current screening estimates 4 . The treatment rate in the current study was twice that observed in the nationwide study (449/2438 = 18.4%) while the control rate (233/449 = 51.8%) was comparable 3 …”

Section: Discussionsupporting

confidence: 85%

“…An earlier study of 2815 participants (1844 were women), aged between 25 and 65 years from Western Nepal showed that nearly 28% of community residents were hypertensive 4 . A larger nationwide study of 13 598 participants who were drawn randomly from all seven provinces found a slightly lower prevalence of hypertension (18%, 95% CI: 16.7–19.2) among aged 15–69 years 3 . Excluding aged 15–29 years, the prevalence stood around 26.7% which is comparable with the current screening estimates 4 .…”

Section: Discussionmentioning

confidence: 97%

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May Measurement Month 2017: an analysis of blood pressure screening results in Nepal—South Asia

Mishra

Shrestha

Poudyal

et al. 2019

European Heart Journal Supplements

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Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants’ homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 97%

May Measurement Month 2017: an analysis of blood pressure screening results in Nepal—South Asia

Mishra

Shrestha

Poudyal

et al. 2019

European Heart Journal Supplements

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“… 6 29 The higher rate of undiagnosed hypertension among males might be due to their lack of awareness and lower treatment rates than females. 32 Smoking, a main source of using tobacco, is well recognised to be associated with an increased risk of hypertension in many settings, including Nepal. 33 34 However, there is a lack of evidence to determine the extent to which tobacco use is related to patients remaining undiagnosed for hypertension.…”

Section: Discussionmentioning

confidence: 99%

Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

et al. 2020

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ObjectiveTo examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.DesignThis study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.SettingNepal.ParticipantsAdult patients with hypertension.ResultsAmong 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=−0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.ConclusionsUndiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

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“…Previous studies looking at the relationship between adiposity and hypertension in this population were heterogeneous in terms of definitions used for overweight and obesity [13, 23–25]. We looked at the association using both WHO and South Asian cut-offs and also for each 5 kg/m 2 increase in BMI.…”

Section: Discussionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

et al. 2019

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BackgroundAlthough there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups.MethodsWe analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI.ResultsThe prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18–24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index.ConclusionsOur study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

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Prevalence, awareness, treatment and control of hypertension in Nepal

Abstract: This nationally representative survey data showed that the prevalence of hypertension is high in Nepal, whereas its awareness, treatment and control rates are low at entire population level.

Cited by 33 publications

References 23 publications

May Measurement Month 2017: an analysis of blood pressure screening results in Nepal—South Asia

May Measurement Month 2017: an analysis of blood pressure screening results in Nepal—South Asia

Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

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