European Journal of Cardiovascular Medicine

Hypertension is a major public health concern and a significant risk factor for cardiovascular diseases, stroke, and renal complications [4]. The epidemiological transition in India has led to an increasing prevalence of hypertension, particularly in urban areas where lifestyle changes have accelerated [5]. However, rural populations are not immune, facing unique challenges such as limited healthcare access and high salt consumption [6].

This study aims to compare the prevalence of hypertension in urban and rural populations of Dehradun and identify key correlates that influence blood pressure regulation in these distinct populations.

Objectives

• To determine the prevalence of hypertension among urban and rural adults in Dehradun.
• To examine sociodemographic and lifestyle factors associated with hypertension.
• To identify differences in risk factor distribution between urban and rural populations.
• To provide evidence-based recommendations for hypertension prevention and control.

Study Design & Population

A cross-sectional study was conducted among 400 adults [200 urban (Premnagar), 200 rural (Kotra Santaur)], aged 30-65 years in Dehradun. Participants were selected through stratified random sampling from community health centres and residential areas [7].

Data Collection

• Blood pressure measurements using a calibrated sphygmomanometer, with hypertension defined as BP ≥140/90 mmHg [8].
• A structured questionnaire assessing demographic details, medical history, lifestyle factors (diet, exercise, smoking, alcohol intake), and family history of hypertension.
• Anthropometric measurements including BMI and waist-hip ratio.

Statistical Analysis

• Descriptive statistics were used to summarize participant characteristics.
• Chi-square tests assessed differences in categorical variables between urban and rural participants.
• Logistic regression identified significant predictors of hypertension [9].

Hypertension prevalence was higher in urban (42%) compared to rural (28%) populations. Key risk factors identified included obesity, physical inactivity, high salt intake, smoking, and alcohol consumption. Urban participants had higher obesity rates (35% vs. 18%), whereas rural participants had higher tobacco use (22% vs. 14%). Multivariate analysis showed significant associations between hypertension and BMI >25 (OR=2.3, p<0.01), sedentary lifestyle (OR=1.9, p<0.05), and excessive salt intake (OR=1.7, p<0.05) [2].

Table 1: Prevalence of Hypertension

Table 2: Lifestyle and Behavioral Factors

Table 3: Clinical Risk Factors

Table 4: Multivariate Analysis of Risk Factors for Hypertension

This study reveals a striking disparity in hypertension prevalence between urban and rural populations, with urban residents demonstrating a significantly higher burden [10]. The lifestyle factors of urban dwellers, including higher obesity rates, physical inactivity, and dietary habits rich in processed foods, are strong contributors [11]. The results suggest that urbanization has led to a more sedentary lifestyle, exacerbating cardiovascular risk factors.

In contrast, while rural populations exhibit lower hypertension prevalence, tobacco consumption remains a concerning factor, with 22% of rural adults being tobacco users compared to 14% in urban areas [12]. This suggests that health interventions must be tailored differently for urban and rural populations, focusing on lifestyle modification for urban settings and tobacco cessation strategies for rural areas.

This study highlights the significant burden of hypertension in urban areas compared to rural regions. The findings indicate that urbanization, characterized by sedentary lifestyles, unhealthy dietary patterns, and increased stress, plays a key role in the rising prevalence of hypertension. Urban participants exhibited higher obesity rates and physical inactivity, both of which are well-established contributors to high blood pressure [4]. These results align with previous research suggesting that urban environments promote behaviors that increase cardiovascular risk factors [5].

The rural population, while exhibiting a lower prevalence of hypertension, still faces health risks, particularly due to tobacco consumption. The significantly higher rate of tobacco use in rural areas (22% vs. 14% in urban areas) suggests that smoking and other forms of tobacco consumption remain a major challenge for cardiovascular health in these communities [6]. These findings support the need for targeted tobacco cessation programs tailored to rural populations.

The strong association between obesity (OR=2.3, p<0.01) and hypertension confirms the well-documented link between excess weight and increased blood pressure levels. The impact of sedentary lifestyles (OR=1.9, p<0.05) further reinforces the importance of promoting physical activity as a preventive measure. Additionally, high salt intake (OR=1.7, p<0.05) was found to be a significant contributor, highlighting the necessity for dietary interventions focused on reducing sodium consumption.

From a public health perspective, these results emphasize the need for community-based interventions targeting modifiable risk factors. Urban populations require strategies to encourage healthier eating habits, physical activity, and stress management, while rural populations would benefit from focused anti-tobacco campaigns and improved access to healthcare services [7].

Overall, this study underscores the urgent need for targeted, region-specific interventions to mitigate the growing burden of hypertension. Future research should explore long-term trends and evaluate the effectiveness of community-based programs in reducing hypertension risk

The study confirms that hypertension prevalence is significantly higher in urban populations, driven by obesity and sedentary behavior, while rural populations face risks associated with tobacco use. Future hypertension control strategies should include:

• Public awareness campaigns on diet and exercise, particularly in urban areas.
• Community-based interventions for reducing tobacco and alcohol consumption in rural settings.
• Strengthening primary healthcare services to improve hypertension screening and management.
• Policy-driven initiatives for salt reduction in processed foods.

Investing in these targeted interventions can contribute to reducing the overall burden of hypertension and associated cardiovascular diseases in Dehradun.

1. World Health Organization. Global status report on noncommunicable diseases 2020.
2. Gupta R, Xavier D. Hypertension: The most important non-communicable disease risk factor in India. Indian Heart J. 2018;70(4):565-572.
3. Das SK, Sanyal K, Basu A. Study of urban-rural differences in prevalence of hypertension. J Indian Med Assoc. 2012;110(4):245-249.
4. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension. Lancet. 2005;365(9455):217-223.
5. ICMR-NCD Risk Factor Survey. Government of India, 2021.
6. Misra A, Singhal N, Khurana L. Obesity, the metabolic syndrome, and type 2 diabetes in developing countries. J Clin Endocrinol Metab. 2010;95(11):4633-4645.
7. Indian Council of Medical Research. Hypertension Guidelines for India, 2019.
8. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289(19):2560-2572.
9. Monitoring trends in hypertension prevalence. World Hypertension Report, 2019.
10. Reddy KS, Prabhakaran D, Jeemon P. Hypertension in the developing world. Lancet. 2021;398(10296):711-723.