TY - JOUR
T1 - Renal and dietary factors associated with hypertension in a setting of disadvantage in rural India
AU - Evans, Roger G.
AU - Subasinghe, Asvini K.
AU - Busingye, Doreen
AU - Srikanth, Velandai K.
AU - Kartik, Kamakshi
AU - Kalyanram, Kartik
AU - Suresh, Oduru
AU - Arabshahi, Simin
AU - Curkpatrick, Isaac
AU - O’Dea, Kerin
AU - Walker, Karen Z.
AU - Kaye, Matthew
AU - Yang, Jun
AU - Thomas, Nihal
AU - Arulappan, Geethanjali
AU - Thrift, Amanda G.
PY - 2021/1/18
Y1 - 2021/1/18
N2 - Using a case-control design, we determined risk factors associated with hypertension in a disadvantaged rural population in southern India. Three hundred adults with hypertension and 300 age- and sex-matched controls were extensively phenotyped. Underweight (29%, body mass index < 18.0 kg m−2), chronic kidney disease (25%, estimated glomerular filtration rate <60 ml min−1 1.73 m−2) and anemia (82%) were highly prevalent. The ratio of sodium to potassium excretion was high (8.2). In multivariable conditional logistic regression of continuous variables dichotomized by their median value, hypertension was independently associated with greater abdominal adiposity as assessed by waist–hip ratio [odds ratio (95% confidence interval), 1.89 (1.21–2.97)], lesser protein intake as assessed by 24 h urea excretion [0.39 (0.24–0.65)], and lesser plasma renin activity [0.54 (0.35–0.84)]. Hypertension tended to be independently associated with lesser serum potassium concentration [0.66 (0.44–1.01), P = 0.06]. Furthermore, those with hypertension reported less frequent intake of vegetables and urinary sodium–potassium ratio correlated positively with serum sodium–potassium ratio (r = 0.18). Hypertension was also independently associated with lesser blood hemoglobin concentration [0.48 (0.26–0.88)]. Blood hemoglobin concentration was positively associated with serum iron (r = 0.41) and ferritin (r = 0.25) concentration and negatively associated with total iron binding capacity (r = −0.17), reflecting iron-deficiency anemia. Our findings indicate potential roles for deficient intake of potassium and protein, and iron-deficiency anemia, in the pathophysiology of hypertension in a setting of disadvantage in rural India. Imbalanced intake of potassium and sodium may be driven partly by deficient intake of vegetables or fruit.
AB - Using a case-control design, we determined risk factors associated with hypertension in a disadvantaged rural population in southern India. Three hundred adults with hypertension and 300 age- and sex-matched controls were extensively phenotyped. Underweight (29%, body mass index < 18.0 kg m−2), chronic kidney disease (25%, estimated glomerular filtration rate <60 ml min−1 1.73 m−2) and anemia (82%) were highly prevalent. The ratio of sodium to potassium excretion was high (8.2). In multivariable conditional logistic regression of continuous variables dichotomized by their median value, hypertension was independently associated with greater abdominal adiposity as assessed by waist–hip ratio [odds ratio (95% confidence interval), 1.89 (1.21–2.97)], lesser protein intake as assessed by 24 h urea excretion [0.39 (0.24–0.65)], and lesser plasma renin activity [0.54 (0.35–0.84)]. Hypertension tended to be independently associated with lesser serum potassium concentration [0.66 (0.44–1.01), P = 0.06]. Furthermore, those with hypertension reported less frequent intake of vegetables and urinary sodium–potassium ratio correlated positively with serum sodium–potassium ratio (r = 0.18). Hypertension was also independently associated with lesser blood hemoglobin concentration [0.48 (0.26–0.88)]. Blood hemoglobin concentration was positively associated with serum iron (r = 0.41) and ferritin (r = 0.25) concentration and negatively associated with total iron binding capacity (r = −0.17), reflecting iron-deficiency anemia. Our findings indicate potential roles for deficient intake of potassium and protein, and iron-deficiency anemia, in the pathophysiology of hypertension in a setting of disadvantage in rural India. Imbalanced intake of potassium and sodium may be driven partly by deficient intake of vegetables or fruit.
UR - http://www.scopus.com/inward/record.url?scp=85100186113&partnerID=8YFLogxK
U2 - 10.1038/s41371-020-00473-5
DO - 10.1038/s41371-020-00473-5
M3 - Article
C2 - 33462389
AN - SCOPUS:85100186113
JO - Journal of Human Hypertension
JF - Journal of Human Hypertension
SN - 0950-9240
ER -