The burden and high prevalence of hypertension in Pakistani adolescents: a meta-analysis of the published studies

Nabi Shah, Qasim Shah, Abdul Jabbar Shah, Nabi Shah, Qasim Shah, Abdul Jabbar Shah

Abstract

Background: Hypertension has been recognized as a global health concern for developing countries and is scarcely described in many of these countries. In Pakistan, few population-based surveys evaluated the prevalence of hypertension and there is no current nationally representative study (the latest nationwide survey was conducted more than two decades ago). Objective: The goal of the current study was to estimate the pooled prevalence of hypertension in Pakistani population using meta-analysis approach.

Methods: We searched the published literature using PubMed, Google and Scopus supplemented by a manual search of bibliographies of retrieved articles for population studies providing estimates on the prevalence of hypertension between 1990 and 2017. Studies were included if they defined hypertension as ≥140/90 mmHg and conducted in adults (≥15 years). From the extracted results, the heterogeneity index of the studies was determined using Chi-squared I2 tests and on the basis of heterogeneity, a fixed or random effect model was used to estimates the pooled prevalence of hypertension. Meta-regression was performed to determine those factor of generating heterogeneity.

Results: Of a total of 1240 articles, 18 studies comprising 42,618 participants met the eligibility criteria. The overall pooled prevalence of hypertension was 26.34% (25.93%, 26.75%). Subgroup analysis showed higher urban prevalence 26.61% (21.80%, 31.42%) than the rural dwellers 21.03% (10.18%, 31.87%). The prevalence by decade in 1990s was 19.55% (18.07%, 21.05%), in 2000s 23.95% (16.60%, 31.30%) and in 2010s 29.95% (24.13%, 35.77%). Similarly, the pooled prevalence was 24.99% (19.70%, 30.28%) in males and 24.76% (16.76%, 32.76%) in females. We recorded high burden of hypertension among the adult Pakistanis when compared to the data published in local and international journals 23.32% (18.9%, 27.74%) and 27.44% (20.97%, 33.91%). We also found differences in the prevalence of hypertension among small, medium and large studies.

Conclusion: Comparing data from previous studies in Pakistan, we found a higher prevalence in urban areas and among males. The prevalence over time is likely to increase faster, further our results underscore the importance of good quality long-term studies that will help to understand hypertension better and implement effective prevention and management programs.

Keywords: Blood pressure; Hypertension; Meta-analysis; Pakistan; Prevalence.

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process. As shown our initial searches resulted in 1240 citations. After screening title and abstracts, 70 studies were considered potentially eligible and retrieved in full text, of these 18 studies were subsequently included in the meta-analysis
Fig. 2
Fig. 2
Forest plot of all selected studies shows prevalence estimates (boxes) with 95% confidence intervals (bar) for each study selected; pooled prevalence estimates are represented as diamonds in this plot
Fig. 3
Fig. 3
Meta-regression of hypertension prevalence against study year
Fig. 4
Fig. 4
a Funnel plot detailing publication bias in the studies reporting the prevalence of hypertension in Pakistan. b Begg’s regression test of the overall prevalence of hypertension. c Egger’s regression test of the overall prevalence of hypertension

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