Urbanization and Prevalence of Hypertension Based on 2017 American Heart Association Guideline for High Blood Pressure in the PURSE-HIS Cohort

Abstract

BACKGROUND: In India, rapid urbanization has had a significant impact on the environment. Little is known about the impact of urban environment on the prevalence of hypertension (HTN). Here we assess the association between HTN and urbanization while controlling for cardiovascular risk factors in the PURSE-HIS cohort, India. METHODS: Based on census data, a random sample included 8080 participants (20–76 yrs of age; 56% female) from urban, semi-urban, or rural areas spread over 80 x 80 km. MODIS satellite land cover data at a 1 km x 1 km resolution was joined to participant's geolocated residential position in ArcGIS to assign urban and rural (crops, trees, shrubs and grass land cover) designations. HTN was diagnosed based on an average of 3 brachial blood pressure measures and the 2017 American Heart Association guideline for HTN diagnosis. Multivariable regression models tested the associations between urbanization measures and HTN, adjusting for age, sex, BMI, physical activity, smoking, socioeconomic, stress, anxiety, cholesterol and sodium intake levels and diabetes status.RESULTS: Based on census, prevalence in urban, semi-urban and rural communities was 49.3%, 41.3% and 31.6%, respectively. Based on MODIS urban, trees, grass and crops land cover, the prevalence was 46.7%, 39.7%, 37.9% and 35%, respectively. In fully adjusted models, urban participants (OR: 2.11 [1.89, 2.36]) and those residing in urban land cover (OR: 1.53 [1.37, 1.69]) had significantly higher odds for HTN when compared to participants in rural areas and crops land cover, respectively.CONCLUSIONS: With close to 50% of the urban population with HTN, there is a significantly higher prevalence of HTN based on the latest (2017) guidelines than previously reported. There is an independent association between urbanization measures and HTN after controlling for cardiovascular risk factors, suggesting unaccounted factors in the urban environment driving the prevalence HTN in urban India.