Prevalence of hypertension in urban, semi-urban, and rural communities in a South Asian population

A cross-sectional study in 8080 adults (mean age 41 years; 56% women) was conducted in 2221 urban, 2821 semi-urban and 3038 rural communities in Tamil Nadu, South India. Measurements included blood pressure (BP), anthropometry, anxiety and stress assessments, smoking and socio-demographics. Hypertension was defined according to JNC-7 guidelines or reported history of hypertension. Isolated hypertension was defined as elevated systolic and normal diastolic BP.

The overall prevalence of hypertension in urban, semi-urban, and rural areas was 44.9%, 31.2%, 21.9% in men and 32.4%, 21.8%, 15.1% in women, respectively. Prevalence of isolated systolic HTN was significantly higher in urban (men 15.5%; women 13.3%) compared to rural (men 3.7%; women 2.7%) participants. Among adults with hypertension, most were previously undiagnosed: 61% urban, 51.4% semi-urban and 56.4% rural.  Among individuals previously diagnosed with hypertension, only 55% urban had controlled BP, whereas nearly 80% of rural individuals had controlled BP.  Multivariable analysis identified age, urbanicity, family history, obesity status, low physical activity and low education level as directly associated with hypertension [all P<0.001], with a 2.8-fold risk in urban (95%CI:2.5-3.2) and 1.4-fold risk in semi-urban (95%CI:1.3-1.7) participants compared to those from rural areas.

Urban communities evidenced higher prevalence of hypertension and concurrent low rates of awareness and control. These findings suggest a pressing need for community-based efforts in the prevention and control of hypertension to avert an epidemic of cardiovascular disease.