Abstract
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.
Highlights
Hypertension is one of the important preventable noncommunicable disease (NCD) risk factors for premature death and disability [1,2,3]
There has been a well-established association between adiposity and hypertension in developed settings [6,7,8], but whether such association is heterogeneous for South Asian population is not well-known
Surveys are based on two-stage stratified sampling of households – firstly, sampling census enumeration areas are selected using probability proportional to size (PPS) sampling technique through statistics provided by the respective national statistical office, and secondly, households are selected through systematic random sampling from the complete listing of households within a selected enumeration area
Summary
Hypertension is one of the important preventable noncommunicable disease (NCD) risk factors for premature death and disability [1,2,3]. There has been a well-established association between adiposity and hypertension in developed settings [6,7,8], but whether such association is heterogeneous for South Asian population is not well-known. Several previous studies have suggested that South Asian adults have substantially lower cut-off points for overweight and obesity than White Europeans, which are associated with higher risks of type 2 diabetes and cardiovascular disease [9, 10]. The associations between overweight and obesity at South Asian cut-offs with hypertension have not been explored adequately in the current literature lacks statistical power, national representation, or adjustments for covariates. 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 examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups
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