Title |
Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension
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Published in |
Heart, January 2017
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DOI | 10.1136/heartjnl-2016-310347 |
Pubmed ID | |
Authors |
Antonio Bernabé-Ortiz, Rodrigo M Carrillo-Larco, Robert H Gilman, William Checkley, Liam Smeeth, J Jaime Miranda, Juan P. Casas, George Davey Smith, Shah Ebrahim, Héctor H. García, Luis Huicho, Germán Málaga, Víctor M. Montori, Gregory B. Diette, Robert H. Gilman, Luis Huicho, Fabiola León-Velarde, María Rivera, Robert A. Wise, William Checkley, Héctor H. García, Robert H. Gilman, J. Jaime Miranda, Katherine Sacksteder |
Abstract |
Most of the data regarding the burden of hypertension in low-income and middle-income countries comes from cross-sectional surveys instead of longitudinal studies. We estimated the incidence of, and risk factors for, hypertension in four study sites with different degree of urbanisation and altitude. Data from the CRONICAS Cohort Study, conducted in urban, semiurban and rural areas in Peru, was used. An age-stratified and sex-stratified random sample of participants was taken from the most updated census available in each site. Hypertension was defined as systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg, or self-report physician diagnosis and current treatment. The exposures were study site and altitude as well as modifiable risk factors. Incidence, incidence rate ratios (IRRs), 95% CIs and population-attributable fractions (PAFs) were estimated using generalised linear models. Information from 3237 participants, mean age 55.8 (SD±12.7) years, 48.4% males, was analysed. Overall baseline prevalence of hypertension was 19.7% (95% CI 18.4% to 21.1%). A total of 375 new cases of hypertension were recorded, including 5266 person-years of follow-up, with an incidence of 7.12 (95% CI 6.44 to 7.88) per 100 person-years. Individuals from semiurban site were at higher risk of hypertension compared with highly urbanised areas (IRR=1.76; 95% CI 1.39 to 2.23); however, those from high-altitude sites had a reduced risk (IRR=0.74; 95% CI 0.58 to 0.95). Obesity was the leading risk factor for hypertension with a great variation according to study site with PAF ranging from 12.5% to 42.4%. Our results suggest heterogeneity in the progression towards hypertension depending on urbanisation and site altitude. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 7 | 41% |
United States | 3 | 18% |
Ireland | 1 | 6% |
Australia | 1 | 6% |
Unknown | 5 | 29% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 7 | 41% |
Scientists | 5 | 29% |
Practitioners (doctors, other healthcare professionals) | 3 | 18% |
Science communicators (journalists, bloggers, editors) | 2 | 12% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 91 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 13 | 14% |
Student > Bachelor | 12 | 13% |
Researcher | 11 | 12% |
Student > Postgraduate | 7 | 8% |
Student > Ph. D. Student | 7 | 8% |
Other | 14 | 15% |
Unknown | 27 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 26 | 29% |
Nursing and Health Professions | 17 | 19% |
Agricultural and Biological Sciences | 3 | 3% |
Arts and Humanities | 3 | 3% |
Mathematics | 2 | 2% |
Other | 9 | 10% |
Unknown | 31 | 34% |