Explaining The Increase Of Hypertension Prevalence In Bangladesh From 2011 To 2018: Evidence From National Surveys

Objective: General trends in the epidemiology of hypertension are best described by studying the same population over time, but studies are limited. Using surveys from Bangladesh in 2011 and 2017-18, we examined i) the change in the prevalence of hypertension, ii) the extent to which changes in traditional hypertension risk factors explained the increase, and iii) the change in the distribution of systolic and diastolic blood pressure over time. Methods: Two independent Bangladesh Demographic and Health Surveys were undertaken in 2011 and 2017-18 using similar methodology in adults aged 35 years and older. Hypertension was defined as having systolic blood pressure (SBP) ≥140 mmHg and/or a diastolic blood pressure (DBP) ≥90 mmHg and/or taking antihypertensive drugs to control blood pressure. Age-standardized prevalence of hypertension was estimated with direct standardization using population census 2011, and a multilevel mixed-effects Poisson regression model with robust variance was used to explain the increase of hypertension from 2011 to 2018. Results: The age-standardized prevalence of hypertension in 2017-18 was 43.4% (95% CI 40.2-46.6) in men and 53.4% (95% CI 50.8-56.0) in women, representing an increase since 2011 of 54% and 8% in men and women, respectively. The age, body mass index, education, and diabetes explained the increase in the prevalence of hypertension from 2011 to 2017-18. We observed statistically significant sex-differences in the increase of hypertension in 2018 (p-difference <0.0001). Increases in SBP and DBP were also seen across the population over the period. Conclusions: In Bangladesh, there has been a marked increase in hypertension prevalence over seven years, especially in men. This largely results from changes in traditional risk factors, leading to population-wide increases in blood pressure levels. Interventions to control this exacerbation of hypertension should focus on population-wide strategies.