Skip to main content

Advertisement

SpringerLink
Log in

Hypertension, pre-hypertension, and associated risk factors in a subsistent farmer community in remote rural central India

  • Original Article
  • Published:
Journal of Public Health Aims and scope Submit manuscript

Abstract

Aim

Eighty percent of global burden of hypertension is in low-income and middle-income areas. We aimed to assess the point prevalence of hypertension, pre-hypertension, associated risk factors, and awareness about high blood pressure in a subsistent farmer community in India.

Methods

We performed a cross-sectional study of randomly selected adults above 40 years in six villages in Jamkhed, measuring blood pressure and abdominal girth, and administering a comprehensive questionnaire with both closed and open-ended questions assessing socio-demographics and risk factors for cardiovascular diseases in the summer of the 2010.

Results

Of 224 adults, 57 % were women. Average age was 56.8 years (±11.76). The majority were farmers, reporting a high salt diet. 30.3 and 38.3 % met the criteria for hypertension and pre-hypertension respectively, and all but 1 was newly detected. High abdominal girth was 8.6 %, and 7.5 % had blood pressure consistent with stage 2 hypertension. Tobacco use was over 80 %. In regression analysis only abdominal girth predicted pre-hypertension.

Conclusion

The age-adjusted high blood pressure rate comparable to the United States and a very low awareness about hypertension are alarming. Role of psychosocial stress and other potential risk factors needs further exploration. A strong public health response with emphasis on prevention, improving awareness, low cost and sustainable interventions for risk factors, and consistent treatment and follow up through community health workers using the existing model for controlling communicable diseases is feasible and warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aje TO, Miller M (2009) Cardiovascular disease: a global problem extending into the developing world. World J Cardiol 1(1):3–10

    Article  PubMed  Google Scholar 

  • Bhardwaj R, Kandori A, Marwah R, Vaidya P, Singh B, Dhiman P, Sharma A (2010) Prevalence, awareness and control of hypertension in rural communities of Himachal Pradesh. J Assoc Physicians India 58:423–429

    PubMed  Google Scholar 

  • CDC-MMWR (2011) Vital Signs: Prevalence, Treatment, and Control of Hypertension- United States, 1999–2002 and 2005–2008. 60(04);103–108. http://www.cdc.gov/mmwr. Accessed 13 December 2011

  • Chanana HB, Talwar PP (1987) Aging in India: its socioeconomic and health implications. Asia Pac Popul J 2(3):23–38

    PubMed  CAS  Google Scholar 

  • Chow C, Cardona M, Raju PK, Iyengar S, Sukumar A, Raju R, Colman S, Madhav P, Raju R, Reddy KS, Celermajer D, Neal B (2007) Cardiovascular disease and risk factors among 345 adults in rural India: the Andhra Pradesh Rural Health Initiative. Int J Cardiol 116(2):180–185

    Article  PubMed  Google Scholar 

  • Clougherty JE, Eisen EA, Slade MD, Kawachi I, Cullen MR (2009) Workplace and risk of hypertension among hourly and salaried aluminum manufacturing employees. Soc Sci Med 68(2):304–313

    Article  PubMed  Google Scholar 

  • Everson-Rose SA, Lewis TT (2005) Psychosocial factors and cardiovascular diseases. Annu Rev Public Health 26:469–500

    Article  PubMed  Google Scholar 

  • Farzadfar F, Murray CJ, Gakidou E, Bossert T, Namdaritabar H, Alikhani S, Moradi G, Delavari A, Jamshidi H, Ezzati M (2012) Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet 379(9810):47–54

    Article  PubMed  Google Scholar 

  • Figueredo VM (2009) The time has come for physicians to take notice: the impact of psychosocial stressors on the heart. Am J Med 122(8):704–712

    Article  PubMed  Google Scholar 

  • Gaziano TA (2005) Cardiovascular disease in the developing world and its cost-effective management. Circulation 112(23):3547–3553

    Article  PubMed  Google Scholar 

  • Gerin W, Chaplin W, Schwartz JE, Holland J, Alter R, Wheeler R, Duong D, Pickering TG (2005) Sustained blood pressure increase after an acute stressor: the effects of the 11 September 2001 attack on the New York City World Trade Center. J Hypertens 23(2):279–284

    Article  PubMed  CAS  Google Scholar 

  • Ghei K, Agarwal S, Subramanyam MA, Subramanian SV (2010) Association between child immunization and availability of health infrastructure in slums in India. Arch Pediatr Adolesc Med 164(3):243–249

    Article  PubMed  Google Scholar 

  • Global risks 2010: a Global risk network report (2010) Geneva, World Economic Forum, high economic impact of NCD. http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2010.pdf. Accessed 29 January 2012

  • Grundy SM, Bryan Brewer H Jr, Cleeman JI, Smith SC Jr, Lenfant C, American Heart Association, National Heart, Lung, and Blood Institute (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109:433–438

    Article  PubMed  Google Scholar 

  • Gruson E, Montaye M, Kee F, Wagner A, Bingham A, Ruidavets JB, Haas B, Evans A, Ferrières J, Ducimetière PP, Amouyel P, Dallongeville J (2010) Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME study. Heart 96(2):136–140

    Article  PubMed  CAS  Google Scholar 

  • Gupta R (2008) Recent trends in coronary heart disease epidemiology in India. Indian Heart J 60(2 Suppl B):B4–18

    Google Scholar 

  • Hamer M, Steptoe A (2012) Cortisol responses to mental stress and incident hypertension in healthy men and women. J Clin Endocrinol Metab 97(1):E29–E34

    Article  PubMed  CAS  Google Scholar 

  • Hypertension Study Group (2001) Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study. Bull WHO 79(6):490–500

    Google Scholar 

  • Initiative for Cardiovascular Health Research in the Developing Countries (1999) http://www.ichealth.org/index.html. Accessed 16 August 2011

  • Janssen I, Katzmarzyk PT, Ross R (2002) Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 162:2074

    Article  PubMed  Google Scholar 

  • Jonas JB, Nangia V, Matin A, Joshi PP, Ughade SN (2010) Prevalence, awareness, control, and association of arterial hypertension in a rural central India population: the Central India Eye and Medical Study. Am J Hypertens 23(4):347–350

    Article  PubMed  Google Scholar 

  • Kaur P, Rao SR, Radhakrishnan E, Rajasekar D, Gupte MD (2012) Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in south India. Int J Public Health 57(1):87–94

    Article  PubMed  Google Scholar 

  • Kearney PM, Whelton M, Reynolds K et al (2005) Global burden of hypertension. Lancet 365(9455):217–223

    PubMed  Google Scholar 

  • Krejcie, Morgan (1970). Determining sample size for research activities. Edu Psychol Measure 30:607–610. http://opa.uprrp.edu/InvInsDocs/KrejcieandMorgan.pdf. Accessed 26 April 2012

  • Kumar S, Mishra CP (2008) Prevalence and spectrum of hypertension in a rural area. Kathmandu Univ Med J (KUMJ) 6(2):181–183

    CAS  Google Scholar 

  • Lawes CM, Vander Hoorn S, Rodgers A (2008) International Society of Hypertension: global burden of blood-pressure-related disease, 2001. Lancet 371(9623):1513–1518

    Article  PubMed  Google Scholar 

  • Liu A, Sullivan S, Khan M, Sachs S, Singh P (2011) Community health workers in global health: scale and scalability. Mt Sinai J Med 78(3):419–435. doi:10.1002/msj.20260

    Article  PubMed  Google Scholar 

  • Midha T, Idris MZ, Saran RK, Srivastav AK, Singh SK (2009) Prevalence and determinants of hypertension in the urban and rural population of a north Indian district. East Afr J Public Health 6(3):268–273

    PubMed  Google Scholar 

  • Mittal BV, Singh AK (2010) Hypertension in the developing world: challenges and opportunities. Am J Kidney Dis 55(3):590–598

    Article  PubMed  Google Scholar 

  • Mohan V, Deepa M, Farooq S, Datta M, Deepa R (2007) Prevalence, awareness and control of hypertension in Chennai: The Chennai Urban Rural Epidemiology Study (CURES-52). J Assoc Physicians India 55:326–332

    PubMed  CAS  Google Scholar 

  • National Institutes of Health, National Heart, Lung, and Blood Institute (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6(suppl 2):S51–S210

    Google Scholar 

  • National Research Council (2010). Promoting Cardiovascular Health in the Developing World: a critical challenge to achieve global health. The National Academies Press, Washington, DC. http://www.nap.edu/openbook.php?record_id=12815&page=19. Accessed 29 January 2012

  • Ness-Abramof R, Apovian CM (2008) Waist circumference measurement in clinical practice. Nutr Clin Pract 23(4):397–404

    Article  PubMed  Google Scholar 

  • Pasco JA, Nicholson GC, Brennan SL, Kotowicz MA (2012) Prevalence of obesity and the relationship between the body mass index and body fat: cross-sectional, population-based data. PLoS One 7(1):e29580

    Article  PubMed  CAS  Google Scholar 

  • Patel AR, Nowalk MP (2010) Expanding immunization coverage in rural India: a review of evidence for the role of community health workers. Vaccine 28(3):604–613

    Article  PubMed  Google Scholar 

  • Pednekar MS, Gupta R, Gupta PC (2009) Association of blood pressure and cardiovascular mortality in India: Mumbai cohort study. Am J Hypertens 22(10):1076–1084

    Article  PubMed  Google Scholar 

  • Prabhakaran D, Yusuf F (2010) Cardiovascular disease in India: lessons learnt and challenges ahead. Indian J Med Res 132(5):529–530

    PubMed  Google Scholar 

  • Rexrode KM, Buring JE, Manson JE (2001) Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord 25(7):1047–1056

    Article  PubMed  CAS  Google Scholar 

  • Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2012) Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 125(1):e2–e220

    Article  PubMed  Google Scholar 

  • Singh RB, Sharma JP, Rastogi V, Raghuvanshi RS, Moshiri M, Verma SP, Janus ED (1997) Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India. Eur Heart J 18(11):1728–1735

    Article  PubMed  CAS  Google Scholar 

  • Spruill TM (2010) Chronic psychosocial stress and hypertension. Curr Hypertens Rep 12(1):10–16

    Article  PubMed  Google Scholar 

  • Subburam R, Sankarapandian M, Gopinath DR, Selvarajan SK, Kabilan L (2009) Prevalence of hypertension and correlates among adults of 45–60 years in a rural area of Tamil Nadu. Indian J Public Health 53(1):37–40

    PubMed  CAS  Google Scholar 

  • The Comprehensive Rural Health Project-Jamkhed (2011) http://jamkhed.org/. Accessed 19 December 2011

  • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2004) National High Blood Pressure Education Program. National Heart, Lung, and Blood Institute, Bethesda, MD

  • Wakabi W (2008) Extension workers drive Ethiopia’s primary health care. Lancet 13;372(9642):880

    Google Scholar 

  • Walley J et al (2008) Primary health care: making Alma-Ata a reality. Lancet 372(9642):1001–1007

    Article  PubMed  Google Scholar 

  • Wang Y, Wang QJ (2004) The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med 164(19):2126–2134

    Article  PubMed  Google Scholar 

  • Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr, Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, Whitsel LP on behalf of the American Heart Association Advocacy Coordinating Committee, Council on Cardiovascular Disease in the Young, Council on the Kidney in Cardiovascular Disease, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Clinical Cardiology, and Stroke Council (2011) Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation 124(8):967–990

    Article  PubMed  CAS  Google Scholar 

  • Wood A, Pell J, Patel A, Neal B, Raju PK, Chow CK (2011) Prevention of cardiovascular disease in rural region of India and strategies to address the unmet need. Heart 97(17):1373–1378

    Article  PubMed  Google Scholar 

  • World Health Organization (2008) Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008. http://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/index.html. Accessed 26 April 2012)

  • World Health Organization (2010) Global status report on non communicable diseases. http://www.who.int/nmh/publications/ncd_report2010/en/. Accessed 20 July 2011

  • World Health Organization (2011a) Cardiovascular Diseases Fact Sheet No. 317. http://www.who.int/mediacentre/factsheets/fs317/en/index.html. Accessed 29 January 29, 2012

  • World Health Organization (2011b) World Health Organization country statistics. http://www.who.int/countries/ind/en/. Accessed August 2011

Download references

Acknowledgements

The authors would like to thank Prem Kumar, PhD, Jamkhed Project for his invaluable assistance in the design of this research. We are extremely thankful to all community health workers and staff at Jamkhed Project for their outstanding work, commitment, and support of this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Montefiore Medical Center, Albert Einstein College of Medicine, 111 E210th Street, New York, NY, 10467, USA

    Ramin Asgary

  2. Department of Medical Education, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Sophie Galson, Hari Shankar & Caitlin O’Brien

  3. Jamkhed Comprehensive Rural Health Project, Dist. Ahmednagar, Maharashtra, 413 201, India

    Shobha Arole

Authors
  1. Ramin Asgary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Galson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hari Shankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caitlin O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shobha Arole
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramin Asgary.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asgary, R., Galson, S., Shankar, H. et al. Hypertension, pre-hypertension, and associated risk factors in a subsistent farmer community in remote rural central India. J Public Health 21, 251–258 (2013). https://doi.org/10.1007/s10389-012-0536-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10389-012-0536-5

Keywords

Search

Navigation