Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension

Antonio Bernabé-Ortiz, Rodrigo M Carrillo-Larco, Robert H Gilman, William Checkley, Liam Smeeth, J Jaime Miranda, CRONICAS Cohort Study Group, 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, Antonio Bernabé-Ortiz, Rodrigo M Carrillo-Larco, Robert H Gilman, William Checkley, Liam Smeeth, J Jaime Miranda, CRONICAS Cohort Study Group, 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

Background: 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.

Methods: 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.

Results: 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%.

Conclusions: Our results suggest heterogeneity in the progression towards hypertension depending on urbanisation and site altitude.

Conflict of interest statement

Competing interests: WC was further supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute. LS is a Senior Clinical Fellow (098504/Z/12/Z) and AB-O is a Research Training Fellow in Public Health and Tropical Medicine (103994/Z/14/Z), both funded by Wellcome Trust.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Modifiable factors and the risk of hypertension: adjusted models and population-attributable fractions (PAFs). *The model was adjusted by sex, age, education level, socioeconomic status and study site. IRR, incidence rate ratio.

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