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Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016
  1. Rajat Das Gupta1,2,
  2. Sojib Bin Zaman3,
  3. Kusum Wagle4,5,
  4. Reese Crispen6,
  5. Mohammad Rashidul Hashan7,
  6. Gulam Muhammed Al Kibria6
  1. 1 Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  2. 2 Centre for Science of Implementation and Scale-Up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  3. 3 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  4. 4 Research Division, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
  5. 5 Department of Public Health, Om Health Campus Pvt. Ltd, Kathmandu, Nepal
  6. 6 Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
  7. 7 Department of Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh
  1. Correspondence to Dr Rajat Das Gupta; rajat89.dasgupta{at}


Objectives This study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines.

Design Cross-sectional study.

Setting This study used data collected from the 2016 Nepal Demographic and Health Survey data.

Participants 13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.

Primary and secondary outcome measures The primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs.

Results About 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50–69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30–49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline.

Conclusions Per both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.

  • key-words:2017 acc/aha
  • JNC7
  • nepal
  • determinants
  • hypertension

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  • Contributors RDG and GMAK conceptualised the study. RDG, SBZ, KW and GMAK designed the study and acquired the data. RDG, SBZ, RC and GMAK conducted the data analysis. RDG, SBZ, KW, RC, MRH and GMAK interpreted the data. RDG and GMAK prepared the first draft. RDG, SBZ, KW, RC, MRH and GMAK participated in critical revision of the manuscript and contributed to its intellectual improvement. All authors went through the final draft and approved it for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The Nepal Health Research Council and ICF International, Rockville, Maryland, USA approved the NDHS 2016 protocol. The electronic approval to use the dataset for this study was obtained from ICF International in February 2019.

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

  • Data availability statement Data are available in a public, open access repository.

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