The current study presented the unique findings based on recently published BDHS (2017-18 (BDHS) data released by Bangladesh's government in 2020. We are very few studies that have examined the prevalence of hypertension according to the new guideline and have compared with previous JNC 7 guidelines6,11. These studies found an absolute change in hypertension prevalence after applying the new 2017 ACC/AHA guidance. The benefit of earlier detecting individuals with hypertension would reduce complications associated with hypertension and cardiovascular morbidity.
Our findings depicted the change in the estimated prevalence of hypertension in Bangladesh as per JNC 7 guidelines and the new 2017 ACC/AHA guidelines developed to classify prehypertension and hypertension status among the human populations. Under these two guidelines, we have found differences in the prevalence rate at the national and individual levels. In the year 2011, according to the new lower blood pressure threshold recommended by 2017 ACC/AHA guidelines, (43.3%) prevalence of hypertension observed in Bangladesh at the national level while (20.9%) documented in the previous recommendation of JNC 76,31,32. Our study shows, the prevalence of hypertension augmented alarmingly in both conditions observed (24.0%) according to JNC 7 and (50.5%) in 2017 ACC/AHA guidelines. The prevalence of hypertension according to JNC 7 was (20.9%) in 20116,31,32, and at least (3.1%) increased found in our present study (24.0%) same fashion observed in the new guidelines 2017 ACC/AHA were at least (7.2%) hypertension prevalence increased. In addition, regardless of the respondents' background status, these findings show the prevalence has been increasing among female participants alarmingly based on the previous studies6,31. When hypertension has been classified based on the 2017 ACC/AHA guideline’s thresholds, a substantial rise of the prevalence observed for all countries such as Nepal, the USA11,33 and Bangladesh12 despite different socioeconomic characteristics. This depicts the alarming increase in the prevalence of hypertension which requires the need of urgent attention from all the stakeholders who are interested in prevention and control of hypertension in Bangladesh.
Interesting, our findings reported a similar prevalence of hypertension among male and female participants. If we compare the finding based on the previous study, the prevalence rate increased among female participants more than male counterparts12,27. The plausible explanation could be biological and behavioural characteristics among the females might have increased over the period. This fact is supported by the previous evidence that females have a higher risk of obesity and diabetes compared with men34,35. This needs females to require more awareness and public health information to control hypertension and minimize adverse complications27. Our study findings reported that people with higher socioeconomic status had higher odds of having hypertension. The higher wealth status participants can generally purchase more consumable resources with a large amount of calorie intake, making them overweight or obese, putting them at a greater risk of being hypertensive than those lower wealth status36,37. This suggests the need for prevention and control program for hypertension in urban areas of Bangladesh.
The prevalence of hypertension was higher among those living in urban areas, which is in line with previous studies where urban people were reported more hypertensive6,27,38,39. The possible reason could be prevailing unhealthy lifestyle factors such as less physical activity, consumption of unhealthy diets among the urban populations might have contributed to the disease burden40–42. However, this finding warrants further detailed investigation of causes for the increased prevalence or odds of hypertension in several Bangladesh divisions27. This finding suggests the need to understand the social inequalities among the rural and urban community, which may have played a role in such variation. Understanding the inequalities mentioned earlier may help design the comprehensive hypertension prevention and control program for Bangladesh peoples.
There is another explanation that would help understand why the prevalence of hypertension is high in urban areas. The study found that higher educated and higher wealth status of people are likely lives in urban areas, resulting from having a sedentary lifestyle such as low physical activity. A lack of open spaces for playing games or physical activity might result in the high-risk prevalence of hypertension27. Since most urban participants are educated, and these had a higher prevalence of hypertension. Thus our study recommends that educated individuals in urban areas need to receive more public health awareness information to control raised blood pressure levels27.
This study identified the potential risk factors of hypertension using both JNC 7 and 2017 ACC/AHA guideline alongside to the estimation of the prevalence. People of older age 25 to more, female, overweight, and obese had relatively higher odds, which is in line with previous studies elsewhere6,11,43–45. Notably, in the current study, administrative divisions, and place of residence were also found significantly associated with hypertension inline with suggest 2017 ACC/AHA guidelines. People from Rangpur division found higher odds in the two guidelines. Much is unknown why the people from Rangpur division owned higher risk of being hypertensive; however, the reason may be because of socioeconomic inequalities such as limited resources, income inequality, low level of education and social safety net programs, poor connectivity with the urban centres, insufficiency or absence of public infrastructure46,47.
The new 2017 ACC/AHA guideline recommends treating stage 1 hypertension with changing lifestyle measures and taking antihypertensive medicines to prevent future cardiovascular disease risks11. Our study findings are significant because it shows that above fifty per cent of adults with hypertension or elevated blood pressure according to the new 2017 ACC/AHA classification require active lifestyles and healthy dietary habits. Public health programs should adequately address this emerging problem; in Bangladesh, emphasis should be paid to prevention and self-management of a condition not only for those with hypertension but also for all adults11. Therefore, it is essential to estimate the prevalence based on both thresholds to control this hypertension burden, which might exacerbate cardiovascular disease. These findings might help future researchers and appropriate authority design any programs and policies regarding control and prevent hypertension burden and overcome this massive public health challenge.
The strengths and weaknesses of this study are accredited. The strength that lies in this study is the generalizability of the findings for Bangladesh since this survey covered nationally representative data covering all divisions. Along with appropriate statistical methods to estimate the weighted prevalence of hypertension from the sample. This study is the first epidemiological study that analyzed the most recent round data sets based on JNC 7 and 2017 ACC/AHA, which present the exact prevalence that might aid the authorities in taking up initiatives to prevent hypertension.
The limitations of the study are appropriately acknowledged. Due to a cross-sectional setup, no causality can not be established, and the individuals' blood pressure was measured three times in a single day. However, both guidelines recommend longitudinal measurement of blood pressure levels to diagnose hypertension11. This survey also used an automated device, though both guidelines recommend recording blood pressure with a sphygmomanometer31,48,49.