Skip Navigation



Journal of Public Health Advance Access published online on September 30, 2008
Journal of Public Health, doi:10.1093/pubmed/fdn078
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Supplementary Data
Right arrow All Versions of this Article:
31/1/47    most recent
fdn078v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Erem, C.
Right arrow Articles by Topbas, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Erem, C.
Right arrow Articles by Topbas, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2008, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study


Cihangir Erem, Professor in Endocrinology and Metabolism1
Arif Hacihasanoglu, Research Assistant1
Mustafa Kocak, Research Assistant1
Orhan Deger, Professor in Biochemistry2
Murat Topbas, Professor in Public Health3

1 Karadeniz Technical University, Faculty of Medicine,Department of Internal Medicine, Division of Endocrinology and Metabolism, The Trabzon Endocrinological Studies Group, Trabzon, Turkey
2 Department of Biochemistry, Trabzon Endocrinological Studies Group, Trabzon, Turkey
3 Department of Public Health, The Trabzon Endocrinological Studies Group, Trabzon, Turkey


Address correspondence to Cihangir Erem, E-mail:cihangirerem{at}hotmail.com/cihangirerem{at}netscape.net

Background To estimate the prevalence, awareness and control of prehypertension (preHT) and hypertension (HT) as defined by JNC-7 criteria in the Trabzon Region and its associations with demographic factors (age, sex, obesity, marital status, reproductive history in women and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, obesity and cardiovascular disease), lifestyle factors (smoking habits, physical activity and alcohol consumption) in the adult population.

Methods In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon and its nine towns. A total of 4809 adult subjects (2601 women and 2208 men) were included in the study. Demographic and socioeconomic factors, family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure (BP) and diastolic BP levels were measured for all subjects. The persons included in the questionnaire were invited to the local medical centers for blood examination between 08:00-10:00 following 12 hours of fasting. The levels of serum glucose (FBG), total cholesterol (Total-C), high density cholesterol (HDL-C), low density cholesterol (LDL-C) and triglycerides were measured with autoanalyzer. Definition and classification of HT was performed according to guidelines from the US JNC-7 report. Prevalence, awareness, treatment and control of HT were assessed.

Results The prevalences of HT and preHT were 44.0% (46.1% in women and 41.6% in men) and 14.5% (12.6% in women and 16.8% in men), respectively. Overall, only 41% of the hypertensive individuals had been previously diagnosed. Furthermore, 54.5% of the hypertensive subjects were being treated with antihypertensive drugs (AHD), but only 24.3% of treated subjects had their BP adequately controlled. Among all hypertensive subjects (known and newly diagnosed), only 5.43% had their BP under control. The prevalence of HT increased with age, being highest in the 60- to 69-year-old age group (84.4%) but lower again in the 70+ age group. Interestingly, the prevalence was 16.9% in the 20-to 29-year old age group. HT was associated positively with marital status, parity, cessation of cigarette smoking, and negatively with level of education, alcohol consumption, current cigarette use, and physical activity. Multinomial logistic regression analysis revealed that HT were significantly associated with age, male gender, BMI, low education level, nonsmoking, positive family history of selected medical conditions, occupation, and parity.

Conclusions The Trabzon Hypertension Study data indicated that HT is very common and is an important health problem in the adult population of Trabzon. Patients who are unaware of their status and treated uncontrolled hypertensives are at high risk of early cardiovascular morbidity and mortality. To control preHT and HT, effective public health education and urgent precautions are needed. The precautions include serious health education, a well-balanced diet and increasing physical activity.

Keywords: associated risk factors, awareness and control, hypertension, prehypertension, prevalence, Trabzon, Turkish population


   Introduction
TOP
 Introduction
Methods
 Results
 Discussion
 Conclusions
 Supplementary data
 Funding
 References
 
Hypertension (HT) is an important public health problem worldwide and is the most widely recognized modifiable risk factor for cardiovascular disease (CVD), cerebrovascular disease (stroke) and end-stage renal disease.1

Worldwide prevalence estimates for HT may be as much as 1 billion individuals, and ~7.1 million deaths per year may be attributable to it.2The prevalence of HT varies widely among different populations, with rates as low as 3.4% in rural Indian men and as high as 72.5% in Polish women.1Differences in genetic background, environmental factors (especially diet and physical activity) and variations in study protocols all influence the prevalence of HT in adults.3In economically developed countries, the prevalence of HT ranged between ~20 and 50%. Although HT is well recognized as a major cause of morbidity and mortality in the economically developed world, the importance of HT in economically developing countries is less well established.1

Recently, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High BP (JNC-7) defined a new set of guidelines for the prevention and management of HT. According to the JNC-7, normal BP is defined as a systolic BP (SBP) less than 120 mmHg and a diastolic BP (DBP) less than 80 mmHg; an SBP of 120–139 mmHg or a DBP of 80–90 mmHg is defined as prehypertension (preHT).4PreHT is not a disease category; however, prehypertensive subjects are known to be at high risk for developing HT, and even slightly elevated BP increases cardiovascular risk.5

HT is also a common and consistent health problem in developing countries, and its prevalence is currently rising steadily.1In Turkey, there have been only a few studies regarding the epidemiology of HT.3,6–8However, whether preHT status is associated with demographic factors or with metabolic profiles in the Turkish population is still unknown.

The aim of this study is to assess the prevalence of preHT and HT according to the new JNC guidelines in the Trabzon Region and to examine its associations with a number of risk factors in a large sample of the Turkish adult population. Further, to evaluate more accurately the current status of HT screening and management in Trabzon, we have included assessments of awareness, treatment and control of HT.


   Methods
TOP
 Introduction
 Methods
Results
 Discussion
 Conclusions
 Supplementary data
 Funding
 References
 
BP measurement and classification
SBP and DBP were measured after the subject had rested for 15 min, using a standardized aneroid sphygmomanometer and cuffs of appropriate sizes (23 x 12.5 cm) by well-trained personnel. The subject's arm was placed at heart level in a sitting position. Measurements were taken thrice and the mean was taken for all cases. If readings varied by >10 mmHg, an additional reading was performed. Participants were advised to avoid cigarette smoking, alcohol, caffeinated beverages and exercise for at least 30 min before their BP measurement. The Korotkoff phase I (appearance) and phase V (disappearance) were recorded for the SBP and DBP, respectively. The classification of normotensives, prehypertensives and hypertensives was based on the classification of BP from the JNC-7.4Normal BP was defined as not being on antihypertensive medication and having an SBP of less than 120 mmHg and DBP of less than 80 mmHg. PreHT was defined as not being on antihypertensive medication and having an SBP of 120–139 mmHg or DBP of 80–89 mmHg. HT was defined based on the JNC-7 cut-off point of 140 mmHg and above for SBP and/or 90 mmHg and above for DBP, and also if the subject was on antihypertensive medication. Stage 1 HT was defined as an SBP of 140–159 mmHg or DBP of 90–99 mmHg and Stage 2 HT SBP ≥160 mmHg or DBP ≥100 mmHg.

Awareness, treatment and control of HT
Subjects with HT were classified into categories of HT awareness, treatment and control as follows:

  1. ‘Awareness’ was defined as a positive response to the question, ‘Did a doctor ever tell you that you have (had) high BP?’.
  2. ‘Treatment’ was defined as the use of any antihypertensive medication.
  3. ‘Controlled Treated HT’ was defined as receiving antihypertensive therapy and having a BP (SBP/DBP) <140/90 mmHg.

Definition of metabolic syndrome
Metabolic syndrome (MetS) was defined according to the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, ATP III) criteria.9

Statistical analysis
Data normality was assessed by the Kolmogorov–Smirnov test. Comparisons among HT groups (normal, preHT and HT) were done with ANOVA (Bonferroni test aspost hoc) for normally categorical data and Kruskal–Wallis test (Mann–WhitneyU-test with Bonferroni correction aspost hoc) for other data. Comparisons, among groups for quantitative data and prevalence of HT were done with the {chi}2 test. For associated risk factors of HT, logistic regression analysis was done. In this analysis, HT and preHT were taken as dependent variables. Univariate logistic regression analysis was modelled and parameters that haveP< 0.20 were included in the model. Therefore, age groups, sex, level of education, cigarette use, alcohol consumption, family history of selected medical conditions, classification of BMI, occupation, household income (US $ per month), marital status, status of physical activity and parity (for women only) were included in the models. Demographic, socioeconomic and lifestyle factors and family history of selected medical conditions were taken as independent variables. Results are shown as arithmetic mean ± standard deviation for continuous data, and percentage for categorical. Polychotomous logistic regression analysis was employed using the multinomial logit model to determine the risk factors for HT and preHT. A linear trend test for the ORs (95% CI) was also conducted, using each of the categorical variables in the model.P <0.05 was considered significant.


   Results
TOP
 Introduction
 Methods
 Results
Discussion
 Conclusions
 Supplementary data
 Funding
 References
 
Prevalence of preHT and HT
The clinical and metabolic characteristics of subjects with preHT and HT and without preHT and HT included in the study are given in Table 1. All values (except for HDL-C) were significantly increased in preHT and HT groups compared with the normal subjects, although HDL-C levels were decreased. The difference in HDL-C levels was due to women with HT.


View this table:
[in this window]
[in a new window]

  		Table 1 Clinical and laboratory characteristics of the study participants by classification of BP

 
The prevalence of HT is shown in Table 2. The overall prevalence of HT was 44%; 46.1% in women and 41.6% in men. Prevalence of HT was higher in women than that in men (P< 0.001). There were some differences in the prevalence of HT in both men and women among towns(X2= 59.1,P< 0.0001 for women;X2= 29.1,P< 0.0001 for men;X2= 64.9,P< 0.0001 for all subjects) (data not shown). The overall prevalence of preHT was 14.5%; 12.6% in women and 16.8% in men. Approximately 58.5% of Turkish adults were found to have preHT or HT.


View this table:
[in this window]
[in a new window]

  		Table 2 The prevalence of preHT and HT in all subjects by gender and age groups ({chi}2= 827.0, df = 20,P< 0.0001 for women; {chi}2= 461.8, df = 20,P< 0.0001 for men; {chi}2= 1227.7, df = 20,P< 0.0001 for all subjects)

 
Prevalence of HT increased steadily with age both for men and women (P< 0.0001), with the highest prevalence in the 60 to 69-year-old age group (84.4%), and the prevalence declined slightly thereafter. The prevalence of HT among women increased markedly from the 20- to 29-year-old age group (15.0%) to the 60- to 69-year-old age group (88.8%,P< 0.0001). Among men, there was a steady increase in the prevalence of HT from the 20- to 29-year-old age group (19.1%) to the 60- to 69-year-old age group (78.8%) (Table 2).

The prevalence of preHT decreased steadily until the 60- to 69-year-old age group, and then stopped changing. However, especially, the prevalence of preHT more prominently and continuously decreased with age in men.

Prevalence of MetS in the prehypertensive and hypertensive groups
The crude prevalence of MetS according to NCEP ATP III criteria in the normotensive, prehypertensive and hypertensive groups was investigated. When stratified by BP groups, 47.2% (54.1% for women and 38.2% for men) of the hypertensive group had the MetS compared with 28% (30% for women and 26.3% for men) in the prehypertensive group and 4.9% (6.2% for women and 3.4% for men) in the normotensive group. Prevalence of MS increased with increasing BP ({chi}2= 603.698,P< 0.0001 for women; {chi}2= 333.400,P< 0.0001 for men; {chi}2= 934.206,P< 0.0001 for all subjects).

Awareness, treatment and control of HT
Table 3shows our findings concerning awareness, treatment and control of HT according to gender and age groups. Among 2118 subjects with HT, only 869 subjects (41%) were aware of their condition, and 1249 (59%) were not aware of their HT. Women were more aware than men (49.3 versus 30.3%,P< 0.05). Prevalence of awareness increased steadily with increasing age in both men and women, but men were less aware than women in each age group. Prevalence of awareness exceeded 65% in subjects aged 60 years and over. Of those aware of their HT, 54.5% (473 of 869) were receiving antihypertensive treatment and the percentage of individuals with controlled HT in these patients was 24.3% (115 of 473). Moreover, control of previously diagnosed HT was poor. Among 869 previously diagnosed hypertensive individuals, the percentage of individuals with controlled HT was 13.2% (115 of 869). Among all hypertensive (known and unknown) subjects (n= 2118), the percentage of controlled HT was 5.43% (115 of 2118). The rate of control in these subjects increased with age both for men and women (P< 0.001), with the highest prevalence in the 60- to 69-year-old age group (9.09%).


View this table:
[in this window]
[in a new window]

  		Table 3 Awareness, treatment, treated/control and control (in all hypertensives) of HT in the study sample by age and gender

 
HT and associated risk factors
Table 4shows univariate relationships of HT with various associated factors. Prevalence of HT steadily increased with degree of obesity, whereas prevalence of preHT decreased with degree of obesity. The highest HT prevalence was found in the morbid obese subjects (89.2%). Among subjects, 13.7% of the normotensives versus 21.9% of the prehypertensives and 42.4% of the hypertensives were categorized as obese, and 35.7% of the normotensives versus 41.1% of the prehypertensives and 35.9% of the hypertensives were overweight according to the WHO criteria.


View this table:
[in this window]
[in a new window]

  		Table 4 Prevalences of preHT and HT in adult Turkish subjects by body mass index (BMI), occupation, level of education, marital status, cigarette smoking, alcohol consumption, degree of physical activity, household income and family history of obesity, diabetes and hypertension and parity

 
When level of education is considered, an inverse relationship is observed between level of education and prevalence of HT (P< 0.0001). Prevalence was highest in illiterate people and lowest in people who graduated from universities or colleges. As education level increases the prevalence of HT decreases.

As for occupation, association with HT was shown in subjects (P< 0.0001). Prevalence of HT is highest in the groups of housewives and agricultural workers and lowest in the unemployed group.

We found a significant association between HT and marital status (P< 0.0001). Prevalence of HT was highest in widows and widowers and lowest in unmarried people.

We observed an association between cigarette use and the prevalence of HT (P< 0.0001). In particular, there was a significant correlation between nonsmoking, cessation of cigarette smoking and prevalence of HT. The percentages of current smokers, nonsmokers and ex-smokers were higher in the HT group than those in the preHT group. Interestingly, prevalence of HT was highest in the nonsmokers and ex-smokers (former smokers) and lowest in the smokers. Also, interestingly, there was an inverse association between alcohol consumption and prevalence of HT (P< 0.0001). Prevalence of HT was highest in the nondrinkers and ex-drinkers (former drinkers) and lowest in drinkers.

We observed an inverse association between physical activity and prevalence of HT (P< 0.0001). Prevalence of HT was increased with decreased physical activity.

There was a negative significant association between household income and prevalence of HT (P< 0.0001). Prevalence of HT decreases, as income level increases.

No significant association was found between the HT and family history of obesity, hypertension, hyperlipidemia, diabetes or CVD.

Among women, a linear association was observed between parity (the number of births) and the prevalence of HT (P< 0.0001). The prevalence was increased with the parity.

As a result of multinomial (linear logistic regression) analysis, odd ratios for each of the demographic factors, socioeconomic factors, lifestyle factors and family history of selected medical conditions are presented in Table 5. In the analysis, HT was significantly associated with the factors: age, male sex, BMI, education level, nonsmoking, family history of selected medical conditions, occupation (housewives and tradesmen) and parity. PreHT was associated with the factors: age, male sex, BMI, education level (only for universities), and occupation (especially housewives).


View this table:
[in this window]
[in a new window]

  		Table 5 Odds ratios (OR) and 95% confidence interval (Cl) for preHT and HT for demographic, socioeconomic, lifestyle factors, and family history of selected medical conditions, comparing to normal group, using polychotomous logistic regression analysis with the multinomial logit model

 
A clear trend towards increased risk of HT was noted with increments in age and BMI, male gender and family history of selected medical conditions.

In Spearman's correlation analysis, HT was positively correlated with age, BMI, WC, WHR, FBG (only for SBP), total-C, TG (only for SBP) and LDL-C (P< 0.001). PreHT was positively correlated with age, BMI, WC, hip girth WHR, FBG, total-C, LDL-C and TG (P< 0.0001).


   Discussion
TOP
 Introduction
 Methods
 Results
 Discussion
Conclusions
 Supplementary data
 Funding
 References
 
Main findings
The prevalence of HT was found to be 44%. The combined prevalence of both preHT and HT was excessively high (58.5%). According to the logistic regression analysis, age, sex, level of education, BMI and a family history of selected medical conditions were found to be associated with the prevalence of pre HT and HT. Only 41% of subjects were aware of their HT, 54.5% of them were receiving antihypertensive treatment, and 24.3% receiving antihypertensive agents were under control. Therefore, only 5.43% of all the hypertensive subjects were under control.

What is known already
HT is a common health problem in developing countries, and its prevalence is currently rising steadily.1The prevalence of HT varies widely among different populations and is somewhat dependent on factors such as race, lifestyle and degree of urbanization.10These differences may reflect the effects of dynamic interactions among genetic, demographic, sociocultural and economic factors. Moreover, the results may be variable in different regions of a country.3,11The prevalence in the worldwide adult population varies from 5.2 to 70.7%.1In various reports about prevalence of HT in Turkey between 1995 and 2003, the prevalence was found to be between 29.6 and 35.5% (the highest prevalence was 36.7% for women and 37.3% for men).3,7,8,11In a previous study performed by us from 1996 to 1997, we reported that the prevalence of SBP and DBP in adults (n= 2646) in the central province of Trabzon city was 12.0 and 8.2%, respectively.6That study was actually about the prevalence of diabetes. Then, in an other study performed by us from February 2001 to September 2002, we also reported that the prevalence of HT in adults (n= 5016) in the central province of Trabzon city and its nine towns was 33.9%; 34.6% in women and 33.2% in men.12That study was about the prevalence of obesity.

In the literature, HT is more prevalent among men than women,13–17although the prevalence is more among women than men in other studies.18–22In the other rare studies, the prevalence of HT was similar among men and women.11,23The variation may be explained by differential distribution in risk factors (e.g. genetic predisposition, dietary factors, lack of physical activity) between women and men across populations. The male gender is an independent risk factor for HT and CVD.17

Age is strongly associated with HT. In many studies, it was reported that the prevalence of HT increased with age.3,7,8,11,14,19,20,24

The level of awareness, treatment and control of HT varies considerably among countries and regions.1In economically developed countries, there were relatively high levels of awareness and treatment, with approximately one-half to two-third of hypertensives aware of their diagnosis and one-third to one-half receiving treatment.1The levels of awareness, treatment and control of HT are especially low in some economically developing countries.1,3,7

What this study adds
This paper reports one of the largest population-based studies of preHT and HT ever conducted, in which the prevalence of PreHT and HT, and associated risk factors were analysed for the first time in the Trabzon Region.

Using the new JNC guidelines (JNC-7 report) in the present study, the prevalence of HT was found to be 44%. The combined prevalence of both preHT and HT was high (58.5%). The estimated prevalence of HT was comparable, being moderately high by international standards. Compared with surveys in other countries, prevalence of HT in Trabzon city is higher than in Italy,25France,18Sweden,25USA,26Canada,13Mexico,14Korea,19South Africa,24China,27Pakistan,20India,15Jamaica,21and Greece,28but is lower than in Germany25and Finland,25and similar to the prevalence in Spain29and England.25

Thus, the prevalence of HT tends to be higher in Western countries than in Asian countries.1However, over the past decade, the prevalence of HT has either remained stable or has decreased in economically developed countries, and has shown a tendency to increase in economically developing countries.1Furthermore, in comparison with 2001–2002, in the present study, prevalence of HT from 2003 to 2005 represented an increase of 23% (25% for women and 20% for men) in the Trabzon city. Changes in lifestyle and dietary habits, economic development and an increase in life expectancy may help to explain the rapid increase in the prevalence and absolute number of subjects with HT in developing countries (e.g. Turkey).

Another important finding of the present study is that the combined prevalence of both preHT and HT in Turkish adults is excessively high (58.5%). To our knowledge, this is the second Turkish study to employ the new category of preHT, in accordance with the definitions established by the JNC-7 report.11

In the present study, the prevalence of HT in women was higher than in men (46.1 versus 41.6%) (especially after age 40). This finding was similar to the previous studies in Turkey.3,7,8However, the odds ratio (OR) for the HT and preHT groups was significantly increased in the male gender in multivariate logistic regression analysis.

In the present study, prevalence increased dramatically with age in both sexes, from ~16.9% among people in their 20s to over 80% among people older than 60 years. The highest prevalence of HT was in the 60- to 69-year-old age group for women (88.8 %) and men (78.8%). The positive associations between ageing and hypertension, diabetes and obesity were illustrated in a Turkish adult population.6,12

Our study has revealed that the MetS is more common among preHT and HT groups than among normotensive groups. Subjects with MetS were at increased risk of development of CVD.30Therefore, the results of the present study suggest that subjects with preHT have a higher risk of CVD. Accordingly, some studies have reported that subjects with preHT have an increased risk of CVD, including coronary atherosclerosis, compared with those with normal BP, supporting the recommendations of the JNC-7 report for physicians to target actively the lifestyle modifications and multiple risk reductions in preHT patients.31

In the present study, the most striking finding related to the awareness of HT was the very high percentage of subjects (59.0%), who had never had their BP checked. The highest unawareness rate was observed in the 20- to 29-year-old age group (89.1%). The rate of awareness of 41% is lower than in the USA26(68.9%), Canada13(58.0%) and Greece28(60.8%), similar to that in Spain29(45.5%), but higher than in Korea32(25.2%).

Among the individuals aware of their hypertensive status, 45% of males and 45.8% of females were not taking antihypertensive drugs (AHDs) in the present study. The rate of treatment of known hypertensive patients by AHD was quite low (54.5%). This rate is higher than in Bulgaria16(36%), Mexico14(46%) and Korea19(22.9%), similar to that in South Africa24(55% among women) and San Marino33(58.6%), but lower than in the USA26(84%). In our study, the rate of use of AHD increased with age, as in previous studies.3,8,16

Control of HT by AHD therapy (treated/control group) was quite low (24%) in the present study. Hypertension control rates vary within countries according to age, race, socio-economic status and quality of health care.34Our results are concordant with the results of previous studies in Turkey.3,7,8Also, the control rate among hypertensives taking AHDs is higher than in Bulgaria16and Mexico,14similar to that in San Marino,33but lower than in USA26and Canada.13

The control rate of HT among all hypertensive (known and unknown) subjects was very low (5.43%) in the present study. The control rate of HT in Trabzon was much lower than in some countries.26,28,33The low control rate is not only related to low awareness, but also to inadequate AHD therapy.3

Several studies have also found that obesity is a principal risk factor for the development of HT.35Overweight or obesity was significantly associated with high BP.6In our study, only 16.7% of HT and 36.5% of preHT were of normal weight. This study demonsrated that obesity was also a serious public health problem in Trabzon. Of the study population, 66.6% were either overweight or obese. A serious educational effort about obesity and its risks should be made for the population. A goal should be established of securing balanced nutrition for the community and increasing physical activity.12

In our study, HT had a strong inverse association with the level of education. The results are in line with previous studies conducted in Turkey and other countries.11,17,19,36Low education was a risk factor for features of HT in the present study. High prevalence of HT in the group with a low education level might result from the fact that the risk factors such stress, working conditions and nutritional habits were more common; or that people in this group had difficulties in reaching health-care services.11

Many studies have reported that low socio-economic status is associated with a higher prevalence of HT15,20,22and a higher mortality rate from CVD.37We observed an association between occupation and employment situation. Prevalence of HT was significantly increased in housewives and agriculture workers. However, OR for the HT was significantly increased in housewives and tradesmen. Doing domestic duties without fixed hours or renumeration, including a constant access to food, and lack of physical activity may contribute to the appearance of obesity and HT in these women. Interestingly, in the present study, we found a high prevalence of HT in agriculture workers. This condition may be explained by the fact that the total working time of agriculturel workers in 1 year is very short, approximately 1–2 months per year, due to the geographical and physical structure and climatic conditions of Trabzon city.

Current smoking is a significant independent risk factor for preHT and HT in both women and men.17,31In other studies, significant association between HT and smoking has not been observed.19,22Cigarette smoking is known to impair insulin action and may lead to insulin resistance. It may also cause high BP by increasing sympathetic activity.38In the present study, we found an association between smoking and HT (Tables 4and5). HT was significantly less frequent in current smokers than in ex-smokers and nonsmokers. The risk of preHT and HT was significantly decreased in current smokers and former smokers in multinomial logistic regression analysis. It is important to point out that our data, similar to other studies, have shown the interesting phenomenon that smokers have lower BP than nonsmokers, and did not refute the fact that smoking is one of the main risk factors of HT.

The ORs for HT were significantly increased in subjects with a family history of obesity, diabetes, hypertension and atherosclerotic heart disease compared with those without family history in the present study. In the literature, subjects with family history of obesity, diabetes, hypertension and atherosclerotic heart disease have a greater prevalence of HT compared with those without such family history.15,17Our results were concordant with the previous studies in the literature.

In the present study, we found that preHT and HT were positively correlated with WC, WHR, FBG, total-C, triglycerides and LDL-C. We did not find a correlation between preHT and HT and HDL-C. There is a strong correlation between body fat and BP. The prevalence of HT is greater in subjects with central obesity, as reflected by a high WC and WHR than in those with peripherial, gluteal fat and low WHR.15Shanthiraniet al.15reported serum total-C, triglycerides, LDL-C and glucose intolerance to be associated with HT. Our results were concordant with the previous studies in the literature.15,18

Limitations of this study
A major limitation of the study is that it was performed only in urban areas. In addition, nutritional habits could not be included.


   Conclusions
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
Supplementary data
 Funding
 References
 
The present study, which first examined the clustering of various risk factors, showed that the prevalence of HT in Turkish adult subjects living in Trabzon was very high. HT is a public health problem that becomes important from the 20s. In the present study, the prevalence of HT in the 20- to 29-year-old age group was 16.9%. Therefore, we recommend that the BP of younger adults should be measured by midwives/nurses/physicians who make periodical house visits in Turkey as a public health measure. Also, subjects living in Trabzon may have a tendency toward HT. Despite the high prevalence of HT, more than one-half of the hypertensive subjects are unaware of their medical status. Only 5.4% of all hypertensives had their BP controlled. Our results emphasize the urgent need for a public health strategy for the prevention, detection and treatment of HT and preHT. Moreover, regular physical activity and weight reduction through education and awareness among people is the key to reduce the burden of HT, preHT and CVD.


   Supplementary data
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Supplementary data
Funding
 References
 
Supplementary data are available at theJournal of Public Healthonline.


   Funding
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Supplementary data
 Funding
References
 
This study was supported by a research grant from the Karadeniz Technical University (Project No. 2003.114.003.5).


   References
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Supplementary data
 Funding
 References
 

  1. Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens (2004) 22:11–19.[Web of Science][Medline]
  2. World Health Report 2002: Reducing risks, promoting health life. (2002) Geneva, Switzerland: World Health Organization. http://www.who.int/whr/2002/.
  3. Altun B, Arici M, Nergizoglu G, et al, for the Turkish Society of Hypertension and Renal Diseases. Prevalence, awareness, treatment and control of hypertension in Turkey (the PatenT study) in 2003. J Hypertens (2005) 23:1817–23.[Web of Science][Medline]
  4. Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA (2003) 289:2560–72.[Abstract/Free Full Text]
  5. Vasan RS, Larson MG, Leip EP, et al. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet (2001) 358:1682–6.[CrossRef][Web of Science][Medline]
  6. Erem C, Yildiz R, Kavgaci H, et al. Prevalence of diabetes, obesity and hypertension in a Turkish population (Trabzon City). Diab Res Clin Pract (2001) 54:203–8.[CrossRef][Web of Science][Medline]
  7. Sonmez HM, Basak O, Camci C, et al. The epidemiology of elevated blood pressure as an estimate for hypertension in Aydin, Turkey. J Hum Hypertens (1999) 13:399–404.[CrossRef][Web of Science][Medline]
  8. Aytekin NT, Pala K, Irgil E, et al. Distribution of blood pressures in Gemlik District, North-west Turkey. Health Soc Care Commun (2002) 10:394–401.[CrossRef]
  9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Adult Treatment Panel III). JAMA (2001) 285:2486–97.[Free Full Text]
  10. Racial/ethnic disparities in prevalence, treatment, and control of hypertension – United States, 1999–2002. MMWR Morb Mortal Wkly Rep (2005) 54:7–9.[Medline]
  11. Onal AE, Erbil S, Ozel S, et al. The prevalence of and risk factors for hypertension in adults living in Istanbul. Blood Press (2004) 13:31–6.[CrossRef][Web of Science][Medline]
  12. Erem C, Arslan C, Hacihasanoglu A, et al. Prevalence of obesity and associated risk factors in a Turkish population (Trabzon City, Turkey). Obes Res (2004) 12:1117–27.[Web of Science][Medline]
  13. Joffres MR, Ghadirian P, Fodor JG, et al. Awareness, treatment, and control of hypertension in Canada. Am J Hypertens (1997) 10:1097–102.[CrossRef][Web of Science][Medline]
  14. Velazquez MO, Rosas PM, Lara EA, et al. Arterial hypertension in Mexico: results of the National Health Survey 2000. Arch Cardiol Mex (2002) 72:71–84.[Medline]
  15. Shanthirani CS, Pradeepa R, Deepa R, et al. Prevalence and risk factors of hypertension in a selected South Indian population—the Chennai Urban Population Study. J Assoc Physicians India (2003) 51:20–7.[Medline]
  16. Stein AD, Stoyanovsky V, Mincheva V, et al. Prevalence, awareness, treatment and control of hypertension in a working Bulgarian population. Eur J Epidemiol (2000) 16:265–70.[CrossRef][Web of Science][Medline]
  17. Jenei Z, Pall D, Katona E, et al. The epidemiology of hypertension and its associated risk factors in the city of Debrecen, Hungary. Public Health (2002) 116:138–44.[Web of Science][Medline]
  18. Asmar R, Vol S, Pannier B, et al. High blood pressure and associated cardiovascular risk factors in France. J Hypertens (2001) 19:1727–32.[CrossRef][Web of Science][Medline]
  19. Choi KM, Park HS, Han JH, et al. Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001. J Hypertens (2006) 24:1515–21.[Web of Science][Medline]
  20. Ahmad K, Jafar TH. Prevalence and determinants of blood pressure screening in Pakistan. J Hypertens (2005) 23:1979–84.[Web of Science][Medline]
  21. Mendez MA, Cooper R, Wilks R, et al. Income, education, and blood pressure in adults in Jamaica, a middle-income developing country. Int J Epidemiol (2003) 32:400–8.[Abstract/Free Full Text]
  22. Jafar TH, Levey AS, Jafary FH, et al. Ethnic subgroup differences in hypertension in Pakistan. J Hypertens (2003) 21:905–12.[CrossRef][Web of Science][Medline]
  23. Lai SW, Li TC, Lin CC, et al. Hypertension and its related factors in Taiwanese elderly people. Yale J Biol Med (2001) 74:89–94.[Medline]
  24. Steyn K, Gaziano TA, Bradshaw D, et al, South African Demographic and Health Coordinating Team. Hypertension in South African adults: results from the Demographic and Health Survey, 1998. J Hypertens (2001) 19:1717–25.[CrossRef][Web of Science][Medline]
  25. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA (2003) 289:2363–9.[Abstract/Free Full Text]
  26. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA (2003) 290:199–206.[Abstract/Free Full Text]
  27. Huang J, Wildman RP, Gu D, et al. Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China. Am J Hypertens (2004) 17:955–62.[CrossRef][Web of Science][Medline]
  28. Stergiou GS, Thomopoulou GC, Skeva II, et al. Prevalence, awareness, treatment, and control of hypertension in Greece: the Didima study. Am J Hypertens (1999) 12:959–65.[CrossRef][Web of Science][Medline]
  29. Banegas JR, Rodriguez-Artalejo F, de la Cruz Troca JJ, et al. Blood pressure in Spain: distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension (1998) 32:998–1002.[Abstract/Free Full Text]
  30. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care (2001) 24:683–9.[Abstract/Free Full Text]
  31. Tsai PS, Ke TL, Huang CJ, et al. Prevalence and determinants of prehypertension status in the Taiwanese general population. J Hypertens (2005) 23:1355–60.[Web of Science][Medline]
  32. Kim JS, Jones DW, Kim SJ, et al. Hypertension in Korea: a national survey. Am J Prev Med (1994) 10:200–4.[Web of Science][Medline]
  33. Mancia G, Parati G, Borghi C, et al, SMOOTH investigators. Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens (2006) 24:837–43.[Web of Science][Medline]
  34. He J, Muntner P, Chen J, et al. Factors associated with hypertension control in the general population of the United States. Arch Intern Med (2002) 162:1051–8.[Abstract/Free Full Text]
  35. Kunz I, Schorr U, Klaus S, et al. Resting metabolic rate and substrate use in obesity hypertension. Hypertension (2000) 36:26–32.[Abstract/Free Full Text]
  36. Diez Roux AV, Chambless L, Merkin SS, et al. Socioeconomic disadvantage and change in blood pressure associated with aging. Circulation (2002) 106:703–10.[Abstract/Free Full Text]
  37. Choiniere R, Lafontaine P, Edwards AC. Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults. Can Med Assoc J (2000) 162:S13–24.[Medline]
  38. Kong C, Nimmo L, Elatrozy T, et al. Smoking is associated with increased hepatic lipase activity, insulin resistance, dyslipidaemia and early atherosclerosis in Type 2 diabetes. Atherosclerosis (2002) 156:373–8.[Web of Science]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Supplementary Data
Right arrow All Versions of this Article:
31/1/47    most recent
fdn078v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Erem, C.
Right arrow Articles by Topbas, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Erem, C.
Right arrow Articles by Topbas, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?