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Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Nepalese adults: findings from a nationwide cross-sectional survey

Published online by Cambridge University Press:  30 August 2019

Rajat Das Gupta Open the ORCID record for Rajat Das Gupta [Opens in a new window] ,
Shams Shabab Haider ,
Ipsita Sutradhar Open the ORCID record for Ipsita Sutradhar [Opens in a new window] ,
Mehedi Hasan ,
Hemraj Joshi ,
Mohammad Rifat Haider  and
Malabika Sarker
Rajat Das Gupta*
Affiliation:
Center for Non-Communicable Diseases and Nutrition, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh Center for Science of Implementation & Scale Up, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Shams Shabab Haider
Affiliation:
Center for Science of Implementation & Scale Up, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Ipsita Sutradhar
Affiliation:
Center for Non-Communicable Diseases and Nutrition, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh Center for Science of Implementation & Scale Up, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Mehedi Hasan
Affiliation:
Center for Non-Communicable Diseases and Nutrition, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh Center for Science of Implementation & Scale Up, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Hemraj Joshi
Affiliation:
Department of Public Health, Modern Technical College, Sanepa, Lalitpur, Nepal
Mohammad Rifat Haider
Affiliation:
Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, USA
Malabika Sarker
Affiliation:
Center for Non-Communicable Diseases and Nutrition, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh Center for Science of Implementation & Scale Up, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh Institute of Public Health, University of Heidelberg, Germany
*
*Corresponding Author. Email: [email protected]
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Abstract

The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.

Keywords

HypertensionMedication adherencedeveloping countries: Nepal
Type
Research Article
Information
Journal of Biosocial Science , Volume 52 , Issue 3 , May 2020 , pp. 412 - 438
Copyright
© Cambridge University Press 2019

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Footnotes

#

These authors contributed equally to this work.

References

Anchala, R, Kannuri, NK, Pant, H, Khan, H, Franco, OH and Di Angelantonio, Eet al. (2014) Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. Journal of Hypertension 32(6), 1170–1177.CrossRefGoogle ScholarPubMed
Aryal, KK, Dangol, R, Gartoulla, P and Subedi, GR (2018) Health Services Availability and Readiness in Seven Provinces of Nepal. DHS Further Analysis Reports No. 115. ICF, Rockville, MD, USA. URL: https://dhsprogram.com/pubs/pdf/FA115/FA115.pdf (accessed 25th December 2018).Google Scholar
Axon, RN, Bradford, WD and Egan, BM (2009) The role of individual time preferences in health behaviors among hypertensive adults: a pilot study. Journal of the American Society of Hypertension 3(1), 35–41.CrossRefGoogle ScholarPubMed
Banach, M and Aronow, WS (2012) Blood pressure j-curve: current concepts. Current Hypertension Reports 14(6), 556–566.CrossRefGoogle ScholarPubMed
Bennett, L, Tamang, S, Onta, P and Thapa, M (2006) Unequal Citizens: Gender, Caste and Ethnic Exclusion in Nepal. Department for International Development and World Bank, Kathmandu. URL: http://documents.worldbank.org/curated/en/201971468061735968/pdf/379660Nepal0GSEA0Summary0Report01PUBLIC1.pdf (accessed 25th December 2018).Google Scholar
Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC, Green, LA and Izzo, JLet al. (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289(19), 2560–2572.CrossRefGoogle ScholarPubMed
Chow, CK, Teo, KK, Rangarajan, S, Islam, S, Gupta, R and Avezum, Aet al. (2013) Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 310(9), 959–968.CrossRefGoogle Scholar
Ettehad, D, Emdin, CA, Kiran, A, Anderson, SG, Callender, T and Emberson, Jet al. (2016) Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 387(10022), 957–967.CrossRefGoogle ScholarPubMed
Filmer, D and Pritchett, LH (2001) Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography 38(1), 115–132.Google ScholarPubMed
Guo, X, Zou, L, Zhang, X, Li, J, Zheng, L and Sun, Zet al. (2011) Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Texas Heart Institute Journal 38(6), 643–652.Google ScholarPubMed
Gupta, R, Kaur, M, Islam, S, Mohan, V, Mony, P and Kumar, Ret al. (2017) Association of household wealth index, educational status, and social capital with hypertension awareness, treatment, and control in South Asia. American Journal of Hypertension 30(4), 373–381.Google ScholarPubMed
Hasan, M, Sutradhar, I, Akter, T, Das Gupta, R, Joshi, H and Haider, MRet al. (2018) Prevalence and determinants of hypertension among adult population in Nepal: data from Nepal Demographic and Health Survey 2016. PLoS One 13(5), e0198028.CrossRefGoogle ScholarPubMed
Hedner, T, Kjeldsen, SE and Narkiewicz, K (2012) State of global health – hypertension burden and control. Blood Pressure 21 (Supplement 1), 1–2.CrossRefGoogle ScholarPubMed
Jolliffe, IT and Cadima, J (2016) Principal component analysis: a review and recent developments. Philosophical Transactions. Series A 374(2065), 20150202.CrossRefGoogle ScholarPubMed
Justin Zaman, M, Patel, A, Jan, S, Hillis, GS, Raju, PK and Neal, Bet al. (2012) Socio-economic distribution of cardiovascular risk factors and knowledge in rural India. International Journal of Epidemiology 41(5), 1302–1314.CrossRefGoogle Scholar
Karmacharya, BM, Koju, RP, LoGerfo, JP, Chan, KC, Mokdad, AH and Shrestha, Aet al. (2017) Awareness, treatment and control of hypertension in Nepal: findings from the Dhulikhel Heart Study. Heart Asia 9(1), 1–8.CrossRefGoogle ScholarPubMed
Khanal, MK, Dhungana, RR, Bhandari, P, Gurung, Y and Paudel, KN (2017) Prevalence, associated factors, awareness, treatment, and control of hypertension: findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal. PLoS One 12(10), e0185806.CrossRefGoogle ScholarPubMed
Lawes, CM, Vander Hoorn, S and Rodgers, A (2008) Global burden of blood-pressure-related disease, 2001. Lancet 371(9623), 1513–1518.CrossRefGoogle ScholarPubMed
Lim, SS, Vos, T, Flaxman, AD, Danaei, G, Shibuya, K and Adair-Rohani, Het al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859), 2224–2260.CrossRefGoogle ScholarPubMed
Maldonado, G and Greenland, S (1993) Simulation study of confounder-selection strategies. American Journal of Epidemiology 138(11), 923–936.CrossRefGoogle ScholarPubMed
Malekzadeh, MM, Etemadi, A, Kamangar, F, Khademi, H, Golozar, A and Islami, Fet al. (2013) Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. Journal of Hypertension 31(7), 1364–1371.CrossRefGoogle Scholar
Maranon, R and Reckelhoff, JF (2013) Sex and gender differences in control of blood pressure. Clinical Science 125(7), 311–318.CrossRefGoogle ScholarPubMed
Mehata, S, Paudel, YR, Dariang, M, Aryal, KK, Lal, BK and Khanal, MNet al. (2017) Trends and inequalities in use of maternal health care services in Nepal: strategy in the search for improvements. BioMed Research International 2017, 5079234CrossRefGoogle ScholarPubMed
Ministry of Health and Population, New ERA and ICF International (2017a) Nepal Health Facility Survey 2015. Ministry of Health and Population (MOHP) [Nepal], Kathmandu, Nepal. URL: https://dhsprogram.com/pubs/pdf/SPA24/SPA24.pdf (accessed 28 April 2018).Google Scholar
Ministry of Health and Population (MOHP) [Nepal], New ERA and ICF International (2017b) Nepal Demographic and Health Survey (2016). Ministry of Health and Population (MOHP) [Nepal], Kathmandu, Nepal. URL: https://www.dhsprogram.com/pubs/pdf/fr336/fr336.pdf (accessed 28 April 2018).Google Scholar
Mishra, SR, Neupane, D, Bhandari, PM, Khanal, V and Kallestrup, P (2015) Burgeoning burden of non-communicable diseases in Nepal: a scoping review. Globalization and Health 11(1), 32.CrossRefGoogle ScholarPubMed
Misra, A, Tandon, N, Ebrahim, S, Sattar, N, Alam, D and Shrivastava, Uet al. (2017) Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. British Medical Journal 357, j1420.CrossRefGoogle ScholarPubMed
Nepali, S, Ghale, S and Hachhethu, K (2018) Federal Nepal: Socio-Cultural Profiles of the Seven Provinces. Governance Facility, Kathmandu. URL: https://www.lahurnip.org/uploads/articles/Federal-Nepal-The-Provinces-SOCIO-CULTURAL-PROFILES-OF-THE-SEVEN-PROVINCES.pdf (accessed 23 June 2019).Google Scholar
Orach, CG (2009) Health equity: challenges in low income countries. African Health Sciences 9 (Supplement 2), S49–51.Google ScholarPubMed
Palafox, B, McKee, M, Balabanova, D, AlHabib, KF, Avezum, AJ and Bahonar, Aet al. (2016) Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries. International Journal for Equity in Health 15(1), 199.CrossRefGoogle ScholarPubMed
Poulter, NR, Prabhakaran, D and Caulfield, M (2015) Hypertension. Lancet 386(9995), 801–812.CrossRefGoogle ScholarPubMed
Rahimi, K, Emdin, CA and MacMahon, S (2015) The epidemiology of blood pressure and its worldwide management. Circulation Research 116(6), 925–936.CrossRefGoogle ScholarPubMed
Rahman, M, Williams, G and Al Mamun, A. (2017) Gender differences in hypertension awareness, antihypertensive use and blood pressure control in Bangladeshi adults: findings from a national cross-sectional survey. Journal of Health, Population and Nutrition 36(1), 23.CrossRefGoogle ScholarPubMed
Rahman, MM, Gilmour, S, Akter, S, Abe, SK, Saito, E and Shibuya, K (2015) Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey. Journal of Hypertension 33(3), 465–472.CrossRefGoogle ScholarPubMed
Rao, CR, Kamath, VG, Shetty, A and Kamath, A (2014) Treatment compliance among patients with hypertension and Type 2 diabetes mellitus in a coastal population of southern India. International Journal of Preventive Medicine 5(8), 992–998.Google Scholar
Sharma, D, Bkc, M, Rajbhandari, S, Raut, R, Baidya, SG and Kafle, PMet al. (2006) Study of prevalence, awareness, and control of hypertension in a suburban area of Kathmandu, Nepal. Indian Heart Journal 58(1), 34–37.Google Scholar
Tibazarwa, KB and Damasceno, AA (2014) Hypertension in developing countries. Canadian Journal of Cardiology 30(5), 527–533.CrossRefGoogle ScholarPubMed
Vaidya, A, Pokharel, PK, Karki, P and Nagesh, S (2007) Exploring the iceberg of hypertension: a community based study in an eastern Nepal town. Kathmandu University Medical Journal 5(3), 349–359.Google Scholar
Vrijens, B, Antoniou, S, Burnier, M, de la Sierra, A and Volpe, M (2017) Current situation of medication adherence in hypertension. Frontiers in Pharmacology 8, 100.CrossRefGoogle ScholarPubMed