Hypertension In Rural Population Research Articles

Assessment of burden of prediabetes and diabetes with oral glucose tolerance test in community-based settings of Bengaluru rural district

ABSTRACT Background and Objective(s): Diabetes is a major public health concern in India. The majority of studies done in rural population lack systematic methodology in estimating the prevalence of diabetes mellitus. Objectives of this study were to estimate the burden of prediabetes, type 2 diabetes mellitus and its associated risk factors among adults (18–69) years in rural Bengaluru, Karnataka. Methods: A cross-sectional study was conducted among adults aged 18–69 years in three villages of Devanahalli taluk of rural Bengaluru between May and October 2019. Behavioural and metabolic risk factors related to diabetes were assessed using WHO-STEPS instrument and IDSP-NCD risk factor tool. Fasting blood glucose and OGTT test were performed, and WHO diagnostic criteria were used to diagnose diabetes mellitus. Results: Prevalence of prediabetes and type 2 diabetes (T2DM) in rural Bengaluru was found to be 6.3% and 10.9%, respectively. Behavioural risk factors related to diabetes measured in the study population were current tobacco use (32.7%), current alcohol use (9.9%), physical inactivity (46.8%) and unhealthy diet (82.3%). Metabolic risk factors measured were obesity (7.5%), central obesity (46.4%), prediabetes (6.3%) and hypertension (24.3%). More than one-thirds of diabetes and three-fourths of hypertension individuals were newly diagnosed by the population-based screening. Conclusion: The burden of diabetes and its risk factors are high due to the health transition occurring in rural population of Bengaluru. Undiagnosed diabetes mellitus and hypertension in rural population as demonstrated by this study highlight the need to strengthen the population-based screening and diagnosis of T2DM and hypertension (HTN) under the national health programme.

Management of primary hypertension in rural populations.

Hypertension affects almost 20% of Canada's population and is even more prevalent in rural locations due to decreased availability of healthcare; lower income levels and levels of formal education; and higher rates of obesity, smoking, and alcohol use, among others. This article uses current evidence to describe the management of primary hypertension in rural populations.

Methylenetetrahydrofolate Reductase C677T Gene Polymorphism as a Risk Factor for Hypertension in a Rural Population.

Hypertension remains a public health burden despite advances in its management. Hence, the search for further risk stratification tools and prevention and new treatment approaches continues. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is associated with hypertension. Interestingly, riboflavin, as a cofactor of MTHFR, may control blood pressure in patients with mutant MTHFR variants. These double benefits of a risk stratification tool and treatment approach make it interesting. Because this polymorphism depends on ethnicity and geographic region, we aimed to determine the association between MTHFR C677T gene polymorphism and hypertension in a rural Indonesian-Sundanese population. This population-based case-control study included 213 hypertensive subjects and 202 nonhypertensive subjects as controls. The TaqMan assay was used to determine the MTHFR C677T genotypes. The odds ratio (OR) with 95% confidence interval (CI) was used to assess the risk of association. There was a significant difference in MTHFR C677T allele frequencies between the hypertensive and control groups (62.9% CC, 34.3% CT, 2.8% TT vs. 77.7% CC, 20.8% CT, 1.5% TT; p=0.004) and between mutant (TT and CT) and wild-type genotypes (CC) (p=0.001). The mutant genotype was associated with a risk of hypertension (OR 2.1; 95% CI 1.3–3.5) when adjusted for age, body mass index, waist circumference, and diabetes mellitus. The mutant of the MTHFR C677T gene increases the risk of hypertension in rural Indonesian-Sundanese population. These findings may be used in future studies to evaluate the effect of riboflavin supplementation in this population.

2 ASSOCIATION BETWEEN SALT SENSITIVE-RELATED GENE POLYMORPHISM AND HYPERTENSION IN RURAL INDONESIAN SUNDANESE POPULATION

Background: Salt sensitivity is a trait in which blood pressure “changes parallel to changes in salt intake.” It is counted as a risk factor for cardiovascular mortality and morbidity, independent of and as powerful as blood pressure. Previous studies have reported the involvement of G Protein-Coupled Receptor Kinase 4 (GRK4) A486 V gene polymorphism with hypertension and salt sensitivity based on ethnic and geographic region. Risk stratification and therapeutic potential associated to salt sensitivity are common background for studies on this gene. As our knowledge, this is the first report of GRK4 A486 V gene polymorphism on hypertension in Indonesian population. Objectives: To investigate the association of GRK4 A486 V gene polymorphism and hypertension in rural population of Indonesia. Methods: A total of 412 Sundanese adults from Gunung Sari Village in Bogor Indonesia, consist of 211 hypertensive subjects and 201 non-hypertensive subjects as a control group were enrolled in this population based case-control study. The genotypes of the GRK4 A486 V were determined by a TaqMan assay. Odds ratio with 95% confidence interval was used to assess the risk of association. Results: Frequency of GRK4 A486 V gene polymorphism were 68.2% and 59.2% in hypertensive and non-hypertensive subjects respectively. After adjustment of age, body mass index, waist circumference, and diabetes mellitus, we observed association between GRK4 A486 V gene polymorphism with hypertension (OR 1,7; 95% CI 1,1–2,7) Conclusions: There is an association between GRK4 A486 V gene polymorphism and hypertension in rural population of Indonesia.

Magnitude and pattern of hypertension in the Niger Delta: a systematic review and meta-analysis of community-based studies.

BackgroundEmerging evidence found that health inequality in the Niger Delta region in Nigeria has continued to worsen due to epidemiological and environmental risks transitions. This study aims to provide an up-to-date review and the secular trends of hypertension prevalence in Niger Delta.MethodsWe systematically searched databases of MEDLINE, EMBASE, African index Medicus and African Journal online from inception to December 30, 2016 for population-based studies providing prevalence estimates of hypertension in the Niger Delta. Eligible studies were included in a random-effect meta-analysis of prevalence and secular trend. The review was reported according to MOOSE guideline.ResultsOverall, 34 eligible studies comprising of data on 32715 participants with mean-age of 38.43 ± 2.0 years were identified and included in the meta-analysis. The pooled result showed that across study settings, the prevalence of hypertension in rural population tended to be higher than those in urban areas, 32.0% (95% confidence interval (CI) 25.13-39.28) vs 24.07% (95% CI 18.13-30.58), however, the difference did not reach a statistical significant level, (P < 0.183). The overall mean SBP was 130.15 (95% CI 126.85-133.45) mmHg, and the DBP was 80.72 (95% CI 78.45-82.95). The estimates also vary significantly in men compared to women; 30.26% (95% CI 23.76-37.17) vs 22.99% (17.60-28.86), P < 0.0001, and among those older than 65 years compared to those aged 45-64 years, and more than 2-fold compared to those between 15-44 years, P < 0.001. We also observed a continuous increase in prevalence of hypertension in the region (trend = 0.139, P = 0.0001), such that for every 10 years increase in participants’ mean age, the prevalence of hypertension increases by 10.43% (95% CI 5.73-15.14), P < 0.001.ConclusionsThis study found evidence that hypertension is a major public health issue in the Niger Delta communities suggesting a positive relationship between socio-economic and lifestyle factors. Improved surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains an important public health priority.

Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations.

As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects’ responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual’s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine.

Applicability of precision medicine approaches to managing hypertension in rural populations

Applicability of precision medicine approaches to managing hypertension in rural populations

A Cross-Sectional study of prevalence of hypertension among women of reproductive age in rural community of Amritsar-A community based study

Hypertension is a growing health problem worldwide. Globalization brought the lifestyle & behavioral modifications and in turn increased the prevalence of lifestyle disorders such as hypertension. According to ICMR report 2007–08, in India, the prevalence of hypertension was varying from 17–21% in all states with marginal rural-urban differences1. At the same time, people of the rural communities were little affected with globalization. With the growing problem of hypertension worldwide there is concern that hypertension in rural population may also be on a rise. Based on this back ground the present study was conducted with an aim to estimate the prevalence of hypertension in childbearing age group of rural women. Methods: This was a cross sectional observational study conducted among 210 randomly selected consented rural women of the village Mallu-nangal, which is also a field practice area of Rural Health Centre of Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar. A structured questionnaire was applied and blood pressures were measured with standardized digital blood pressure apparatus. Joint national committee-7 classification was used to estimate the prevalence of hypertension. Data was analyzed statistically and Chi-square & other correlation tests were used to test significance of results. Results: Out of the 210 participants, 173 (82.4%) had normal blood pressure, 44 (21%) had pre-hypertension, 34 (16.2%) participants stage I hypertension and 3 (1.4%) participants had stage II hypertension. Conclusions: Prevalence of hypertension and pre-hypertension was 17.6% and 21% respectively. Increasing age, high BMI, family history of hypertension, extra salt intake in food were the associated factors with hypertension.

Factors associated with awareness, treatment and control of hypertension in a disadvantaged rural Indian population.

The aim of this study was to identify factors associated with awareness, treatment and control of hypertension in a rural setting in India. Following screening of the population, all individuals with hypertension (blood pressure (BP) ⩾140/90 mm Hg or taking antihypertensive medications) were invited to participate in this study. We measured BP, height, weight, skinfolds, waist and hip circumference, and administered a questionnaire to obtain information regarding socioeconomic and behavioural characteristics. Multivariable logistic regression was used to determine factors associated with awareness, treatment and control of hypertension. We recruited 277 individuals with hypertension. Awareness (43%), treatment (33%) and control (27%) of hypertension were poor. Greater distance to health services (odds ratio (OR) 0.56 (95% confidence interval (CI)) 0.32-0.98) was associated with poor awareness of hypertension while having had BP measured within the previous year (OR 4.72, 95% CI 2.71-8.22), older age and greater per cent body fat were associated with better awareness. Factors associated with treatment of hypertension were having had BP measured within the previous year (OR 6.18, 95% CI 3.23-11.82), age ⩾65 years, physical inactivity and greater per cent body fat. The only factor associated with control of hypertension was greater per cent body fat (OR 1.05, 95% CI 1.01-1.11). Improving geographic access and utilisation of health services should improve awareness and treatment of hypertension in this rural population. Further research is necessary to determine drivers of control.

基于女性特征血压分布的相关性分析

针对辽宁阜新地区农村人群的高血压流行病学调查数据，以多维标度法(MDS)方法体系中基于χ2统计量的关联性度量方法为主，辅以Somers和Kendall关联性度量方法，分析和探讨女性特征对血压分布的影响。重点分析了40~54岁的女性绝经与否和生育胎数两个因素对血压的影响。数据分析表明，绝经与否对收缩压影响显著地大于对舒张压的影响，在血压等级迁移的敏感性方面，已绝经女性从正常高值向轻度和中度高血压迁移的机会大于未绝经女性，且在由正常高值向轻度高血压迁移上收缩压更敏感。对生育胎数因素，分析表明，生育第3胎对血压存在特异性影响，生育3胎的女性收缩压由中度迁移为重度、舒张压下由轻度迁移为中度级别的风险大。在绝经与否和生育胎数两个因素的交互影响上，生育胎数在收缩压上的影响应重点关注在绝经之前，而绝经特征对生育胎数在收缩压上的影响较为一致，而对舒张压的影响却极为复杂。 According to the data of epidemiological survey on hypertension in rural population of Fuxin, Liaoning province, the method of correlation measurement based on χ2 statistic in the MDS method system are mainly used, and supported by Somers and Kendall correlation to analyze and discuss the effects of female characteristics on blood pressure distribution. This paper mainly analyzes the effects of two factors of menopause for women aged 40-54 and the number of births on blood pressure. For the factor of menopause, the data analysis shows that menopause has greater effects on systolic blood pressure than diastolic blood pressure. In the sensitivity of blood pressure level migration, the chance is greater for post-menopausal women migrating from high normal to mild and moderate blood pressure than non-menopausal women, and systolic blood pressure is more sensitive migrating from high normal to mild blood pressure. For the factor of the number of births, the data analysis shows being equal to 3 has special effects on blood pressure. For women who have 3 children have higher risk on systolic blood pressure migrating from moderate to severity, diastolic blood pressure migrating from mild to moderate. In the interactive effects between menopause or not and the number of births, the effects the number of births has on diastolic blood pressure should focus on pre-menopause. The effect menopause has on the number of births is consistent on systolic blood pressure, while is complicated on diastolic blood pressure.

The study of social-demographic and other determinants of hypertension in a rural population of North India, Delhi, India

Background: Hypertension is emerging as a major public health problem in India and also increasing in rural population.Methods: The Community based Cross-sectional study was carried out during the year 2014 in rural area of Delhi, with the objectives to estimate the prevalence of Hypertension and to identify associated socio-demographic and other determinants.Results: Prevalence of Hypertension in rural population was found to be 21.2%; in men was 23.1% and in women it was 19.2% in the population age 20 years and above. Age, BMI, high salt-Intake, alcohol consumption, family history of hypertension was found to be significantly associated with hypertension.Conclusions: Based on high prevalence, it is recommended that a basic protocol for screening of hypertension should be made for rural population which can be used for prevention, early diagnosis, and for prevention of complications.

A study of prevalence and certain lifestyle risk factors of essential hypertension in a rural area in Telangana, India

Background: Hypertension (Hypertension) with all its complications has emerged as one of the most important non communicable diseases in urban as well as rural areas of India. Effective surveillance of the disease involves collection of accurate data on its prevalence and its risk factors. In rural India, there is a dearth of data on the prevalence and risk factors of Hypertension, especially of the lifestyle-related risk factors. This information is essential to plan prevention strategies. Objective: To assess the prevalence of Hypertension in rural population of the field practice area of Cherlapally among adults above the age group of 30 years and to determine the lifestyle risk factors for Hypertension in the abovementioned study population. Materials and Methods: A cross-sectional study was undertaken in a rural area of Nalgonda District, Telangana, India, to determine the prevalence of the disease and certain lifestyle risk factors using the World Health Organization STEP wise approach to surveillance methodology. A total of 1,500 persons from six villages drawn by multistage systematic random sampling were studied. Result: The prevalence of Hypertension was 24.5% in men, 20.7% in women, and 22.5% in total. The prevalence of prehypertension, stage I Hypertension, and stage II Hypertension were 26.9%, 7.5%, and 3.0%, respectively, the prevalence of Hypertension was seen to increase with age in both the genders. Association of Hypertension with tobacco use, high body mass index, abdominal obesity, high salt intake, and physical inactivity during work, transport, and leisure of study subjects was statistically highly significant. Conclusion: The need to have targeted programs to modify and reduce the impact of lifestyle risk factors has been identified as an important strategy for rural areas.

Hypertension, a Neglected Disease in Rural and Urban Areas in Moramanga, Madagascar

BackgroundHypertension is one of the main risk factors of cardiovascular diseases. In Madagascar, studies on hypertension in urban and rural communities are scarce.ObjectivesThe aim of this study was to determine the prevalence of hypertension and identify associated risk factors in adults living in a health and demographic system in Moramanga, Madagascar.MethodsThe study included people aged 15 years old and above living in a health and demographic system in Moramanga. A household census was performed in 2012 to enumerate the population in 3 communities in Moramanga. In addition to the questionnaire used in the initial census, a standardized questionnaire and blood pressure were taken twice after 5 and 10 minutes of rest. In urban areas, heights and weights were also measured to calculate the body mass index.ResultsThere were 3621 and 4010 participants respectively in rural and urban areas. Prevalence of hypertension in rural population was 27.0% (IC95% [25.6–28.5]) and 29.7% (IC95% [28.3–31.1]) in urban population. Among hypertensive subjects, 1.7% (17/979) and 5.3% (64/1191) were on antihypertensive treatment for at least 1 month before the survey in rural and urban population, respectively. In rural areas, increasing age (65 years and older vs 18–25 years OR = 11.81, IC95% [7.79–18.07]), giving more than 3 positive responses to the usual risks factors of hypertension (OR = 1.67, IC95% [1.14–2.42]) and singles in comparison with married people (OR = 1.61, IC95% [1.20–2.17]) were associated to hypertension in a logistic regression model. In urban areas, increasing age (65 years and older vs 18–25 years OR = 37.54, IC95% [24.81–57.92]), more than 3 positive responses to the usual risks of hypertension (OR = 3.47, IC95% [2.58–4.67]) and obesity (OR = 2.45, IC95% [1.56–3.87]) were found as risk factors.ConclusionHypertension is highly prevalent in rural areas although it is significantly less treated. As a result, a major epidemic of cardiovascular diseases is at risk in Madagascar’s progressively aging society.

Burden and Determinants of Hypertension in Rural Pondicherry, India

We found it interesting to read the article. Hypertension is an important public health challenge worldwide. Estimation of hypertension prevalence in various region helps in implementing health policies to reduce the burden of the disease. An attempt has been made to know the burden and determinants of hypertension in rural population. Population based knowledge about the magnitude and a determinant of hypertension in rural areas is scarce. Present study shows high prevalence of hypertension [24.7%] as compared to study done in Vietnam rural population [14.1%] [1] and less the overall global population prevalence[ 26·4%] [2].Although demographic changes in populations will have the greatest short-term consequences for changes in population blood pressure distributions and hypertension prevalence, other factors are likely to augment these changes. In particular, progress in economic development, with consequent increases in obesity because of greater food availability and choice, and a reduction in physical activity can be expected to further increase mean blood pressure levels and the proportion with high blood pressure in lower income regions such as China and India in concurrence with present study [3]. However, the present study can be strengthened by genetic study as genetic elements contribute to 30% to 50% of the blood pressure variability [4].

Do the socioeconomic and hypertension gradients in rural populations of low- and middle-income countries differ by geographical region? A systematic review and meta-analysis.

Of the 1 billion people with hypertension globally, two-thirds reside in low- and middle-income countries (LMICs). The risk of hypertension in LMICs is thought to be positively associated with socioeconomic status (SES). However, recent studies have provided data inconsistent with this concept. Thus, we assessed the association between SES and hypertension in rural populations of LMICs. Further, we explored whether this association differs according to geographical region. Through a search of databases we identified population-based studies that presented risk estimates for the association between SES, or any of its proxies, and hypertension. Meta-analyses were conducted using a random effects model. Overall, no association was detected between educational status and hypertension, whereas a positive association was observed with income. Interestingly, educational status was inversely associated with hypertension in East Asia {effect size [ES] 0.82 [95% confidence interval (CI) 0.78, 0.87]} but positively associated in South Asia [ES 1.28 (95% CI 1.14, 1.43)]. Higher income, household assets or social class were positively associated with hypertension in South Asia whereas no association was detected in East Asia and Africa. Compared with other occupations, farmers or manual labourers were associated with a lower risk for hypertension. Further, in regions such as Latin America, few studies were identified that fulfilled our inclusion criteria. We provide evidence that the association between hypertension and SES in rural populations of LMICs in Asia varies according to geographical region. This has important implications for targeting intervention strategies aimed at high-risk populations in different geographical regions.

Abstract P386: Salt is an Important Risk Factor for Hypertension in Rural Disadvantaged Populations

Introduction: Hypertension is the greatest contributor to mortality globally, and its prevalence is high in low to middle income countries (LMICs). High salt intake and poor dietary choices are associated with the risk of hypertension, but their role in rural areas of LMICs is unclear. Hypotheses: We aimed to establish the prevalence of high salt intake and to examine whether there is a clear relationship between high salt intake and hypertension in disadvantaged rural settings. We also aimed to assess the available information about the association of hypertension with other dietary factors. Methods: We searched electronic databases to identify studies in rural LMICs, in which the association of salt and other dietary factors with hypertension were assessed using multivariable models. A meta-analysis was conducted to assess these associations using a random effects model. Results: We identified 13 studies with a total of 134,404 participants for the systematic review. The pooled effect sizes (ESs) and 95% confidence intervals (CIs) for studies in which salt intake was assessed as a categorical variable (n=5) were 1.31 (95% CI: 1.19,1.44) in all participants, 1.70 (0.99,2.92) in males and 1.27 (95% CI: 1.04,1.54) in females. We also found a positive association between fat intake and the risk of hypertension (n=2) 1.47 (95% CI: 1.13, 1.90).There were few studies of other dietary factors and hypertension in rural regions of LMICs. Conclusions: To the best of our knowledge, no other systematic review and or meta-analyses have been conducted to investigate the relationship between diet and hypertension in rural populations of LMICs. Our findings show that high salt intake is a significant risk factor for hypertension in rural areas of LMICs. We also show a large gap in the literature regarding the relationship between dietary factors other than salt with the risk of hypertension. Salt reduction strategies should be implemented on a community level in these populations in order to drive a change in dietary behaviour.

Prevalence of hypertension in rural populations from Ibero-America and the Caribbean

Hypertension and cardiovascular risk factors are widespread in developing countries, but little is known about cardiovascular risk profiles in rural communities from Ibero-America and the Caribbean. The aim of the present study was to evaluate the peer-reviewed literature published from 1990 to 2012 relating to the prevalence of hypertension in rural populations from Ibero-America and the Caribbean. A bibliographic search was conducted in MEDLINE, SCIELO and LILACS databases. Included were population-based studies in which prevalence of hypertension in adults was reported. A total of 30 peer-reviewed publications were identified that reported the prevalence of hypertension in 33 143 patients. The crude hypertension prevalence reported from rural Ibero-America was 32.6% (95% confidence interval: 31.4-32.5%; range: 1.8-52%). The prevalence of hypertension was lower in aboriginal populations than in other rural communities (19.5% vs 36%). Only nine studies assessed the awareness, treatment, and level of control of hypertension (means 54%, 57%, and 14% respectively). The most prevalent cardiovascular risk factors were abdominal obesity (39%) and overweight (39%). Hypertension is of public health importance in rural Ibero-America and the Caribbean, with evidence of considerable under-diagnosis, treatment, and control. There is an urgent need to develop strategies to prevent, detect, treat, and control hypertension effectively in this region.

English

BACKGROUND: Hypertension is one of the important causes of cardiovascular morbidity and mortality. With change in lifestyle and increase in life expectancy in India, hypertension is emerging as an important public health problem. AIM & OBJECTIVES: To asses the prevalence of hypertension in rural population To correlate the prevalence with epidemiological factors. METHODS: A community based cross sectional survey was conducted in rural Kerala and 459 subjects were studied. Height weight and blood pressure of subjects were measured using standardized techniques. RESULTS: The overall prevalence of hypertension in our study was 19.82%. Prevalence of hypertension increased with age but did not vary with sex. The prevalence of hypertension was strongly associated with body mass index (BMI). CONCLUSIONS: This rural study showed a high prevalence of hypertension. This observation emphasises need to improve screening, treatment and control of hypertension in this population.

The Prevalence rate of Hypertension in Rural Population of Bangladesh

Background: The non-communicable diseases like hypertension, diabetes and asthma are emerging as a major health problem in Bangladesh. Recently, these are given high research priority by the Government of Bangladesh. The prevalence of hypertension is increasing rapidly, but there is no current study on prevalence of hypertension in rural population of Bangladesh. There are some studies conducted on prevalence of hypertension from mid 70's to late 90's. Those studies showed the prevalence of hypertension is increasing significantly in both urban and rural population. In rural population the prevalence of hypertension was in 23.6% 1. After that there is no population based study was conducted on prevalence of hypertension in rural population of Bangladesh. Methods: We measured blood pressure, body weight and height of 532 individuals at and above the age of 20 years (age range 20-70 years) of both sexes accept pregnant and those who were under medication of hypertension. We collected information about smoking, family history of hypertension, status of physical activity, diabetes, annual income etc. Result: The overall prevalence rate of hypertension was 30.64% (male 31.53% and female 29.36%). In the study, the blood pressure was measured in all study subjects. The mean blood pressure was higher in hypertensive participants than that of non hypertensive. The prevalence of hypertension (30.64%) observed in this study was higher than the previous study. In this study showed that with the increasing age more the prevalence of hypertension. The similar funding also observed in recent Indian study. Our study showed that the hypertension prevalence was high among people with high BMI and obesity, positive family history, smoking and less physical activity. Conclusion: The prevalence of hypertension in the rural population was found to be on the increased compare to previous reports of Bangladesh and other Asian studies. Advanced age, obesity, higher incomes, family history of hypertension, smoking and reduced physical activity were proved significant risk factors for hypertension, whereas, sex, occupation, showed no association with hypertension. DOI: http://dx.doi.org/10.3329/jdnmch.v18i1.12225 J. Dhaka National Med. Coll. Hos. 2012; 18 (01): 12-17

Optimizing Hypertension Management in Underserved Rural Populations

Rural populations across the United States have an increased likelihood of developing hypertension and diabetes, which are significant risk factors for cardiovascular disease (CVD), including stroke and myocardial infarction. Limited access to care due to geography or socioeconomic status significantly impairs control of hypertension in rural populations, resulting in poor health outcomes. Epidemiological studies suggest that the prevalence of uncontrolled hypertension and poor glycemic control are affected by race, increasing age, and residence in the rural southeastern United States. Optimization of the delivery of rural health care is needed to improve outcomes in patients with hypertension. New strategies such as programs targeting therapeutic inertia, home-based monitoring of blood pressure (BP), and Internet-based communication programs may significantly improve BP control rates among rural patients. Among hypertensive medications, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended by consensus guidelines and may be particularly effective in rural, minority populations due to their secondary effects on decreasing CVD.