Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: A cross-sectional analysis of the demographic and health survey 2016

Abstract

Objectives: This study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines.

Design: Cross-sectional study.

Setting: This study used data collected from the 2016 Nepal Demographic and Health Survey data.

Participants: 13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.

Primary and secondary outcome measures: The primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs.

Results: About 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50-69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30-49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline.

Conclusions: Per both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.