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Special populations
Original article
Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension
  1. Antonio Bernabé-Ortiz1,2,
  2. Rodrigo M Carrillo-Larco1,
  3. Robert H Gilman1,3,4,
  4. William Checkley1,5,
  5. Liam Smeeth2,
  6. J Jaime Miranda1,6,
  7. CRONICAS Cohort Study Group
    1. 1CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
    2. 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
    3. 3Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
    4. 4Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
    5. 5Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
    6. 6Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
    1. Correspondence to Dr Jaime Miranda, CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru; Jaime.Miranda{at}upch.pe

    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.

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

    https://doi.org/10.1136/heartjnl-2016-310347

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      Footnotes

      • Collaborators CRONICAS Cohort Study Group. Cardiovascular disease: Antonio Bernabé-Ortiz, Juan P. Casas, George Davey Smith, Shah Ebrahim, Héctor H. García, Robert H. Gilman, Luis Huicho, Germán Málaga, J. Jaime Miranda, Víctor M. Montori and Liam Smeeth. Chronic obstructive pulmonary disease: William Checkley, Gregory B. Diette, Robert H. Gilman, Luis Huicho, Fabiola León-Velarde, María Rivera and Robert A. Wise. Training and capacity building: William Checkley, Héctor H. García, Robert H. Gilman, J. Jaime Miranda and Katherine Sacksteder.

      • Contributors AB-O, RMC-L and JJM conceived the idea of the manuscript. AB-O drafted the first version of the manuscript and led the statistical analysis with support of RMC-L. JJM, RHG, WC and LS conceived, designed and supervised the overall study. JJM, AB-O and WC coordinated and supervised fieldwork activities in Lima, Tumbes and Puno. All authors participated in writing of manuscript, provided important intellectual content and gave their final approval of the version submitted for publication.

      • Funding This project has been funded in whole with federal funds from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract no HHSN268200900033C.

      • 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.

      • Patient consent Obtained.

      • Ethics approval The study was reviewed and approved by the Institutional Review Board of Universidad Peruana Cayetano Heredia and Asociación Benéfica PRISMA, in Lima, Peru, and Johns Hopkins University, in Baltimore, Maryland, USA.

      • Provenance and peer review Not commissioned; externally peer reviewed.