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Hypertension in rural India: novel risk factors, knowledge, awareness, treatment and control
thesisposted on 22.02.2017, 01:26 by Busingye, Doreen
Introduction: The prevalence of hypertension in disadvantaged rural Indian populations is increasing, but the specific risk factors and factors associated with its awareness, treatment and control are largely unknown. In order to carry out effective control and preventive strategies for hypertension in these populations, it is important to understand the underlying risk factors and the factors associated with its awareness, treatment and control. Therefore, the main objective of this study was to determine novel risk factors for hypertension and identify factors associated with its awareness, treatment and control in a disadvantaged rural population of South India. Methods: This study employed case-control methods in which individuals with (cases) and without (controls) hypertension were matched in a 1:1 ratio by age, sex, and, where possible, hamlet. Data on clinical, biological and physical measurements; health status; socioeconomic and behavioural factors; as well as other hypertension related data such as self-reported knowledge, awareness and treatment were collected. Multivariable conditional logistic regression analysis was used to determine factors associated with hypertension while multivariable logistic regression was used to determine factors associated with its awareness, treatment and control. Results: This analysis comprises a partial sample of participants, being preliminary findings from 211 cases and 211 controls. Generally, our findings of the association between infection and hypertension were inconsistent. No association was detected between hypertension and exposure to bacterial contaminated water, history of infection or overcrowding. Interestingly, we found that compared to individuals who used a toilet, those who resided (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.39 – 8.35, p=0.007) or drew water from a water supply (OR 2.84, 95% CI 1.21 – 6.66, p=0.02) that was within 50 metres of a field used for toilet purposes had greater odds of hypertension. A modest positive association was detected between hypertension and number of teeth lost while a modest negative association was detected between hypertension and gum disease. Individuals with high sensitive C-reactive protein (hs-CRP) levels of 1–3 mg/L had a twofold increase in the risk of hypertension compared to those with hs-CRP levels < 1 mg/L, but no association was detected in those with > 3 mg/L. Knowledge about risk factors for hypertension, as well as awareness, treatment and control of hypertension were very poor in this population. Importantly, older age, formal schooling, greater percent body fat, regular health check-up and proximity to health services were associated with better awareness of hypertension. Similar findings were observed for treatment with the exception of formal schooling and proximity to health services. Control of hypertension was poor in older individuals. Conclusion: Given the inconsistency and interim nature of our findings, the association between hypertension and infection or inflammation in this population is still equivocal. Further investigation of these factors in studies employing robust measures of infection or incorporating long-term follow up, such as longitudinal studies to ascertain whether the presence of infection is associated with development of hypertension, will further advance understanding of these potential risk factors for hypertension. Nevertheless, our findings are important for generation of new hypotheses and also provide a firm knowledge base from which to formulate preventive and intervention strategies tailored to specific needs of this community. This is important in reducing the burden of hypertension in disadvantaged rural populations in India and potentially in other poor regions of low- and middle-income countries.