European Journal of Cardiovascular Medicine

Hypertension, commonly referred to as high blood pressure, remains a significant public health challenge globally due to its high prevalence and role as a primary risk factor for cardiovascular diseases. Despite extensive research, hypertension continues to exhibit varying prevalence rates across different geographical and socio-economic backgrounds, necessitating continual study, particularly contrasting urban and rural settings.^[1][2]

Urban environments are characterized by lifestyle factors such as higher stress levels, greater prevalence of obesity due to sedentary lifestyles, and higher consumption of processed foods. These factors contribute to the higher incidence of hypertension observed in urban populations. Conversely, rural populations, while generally more active and consuming a diet richer in organic substances, may suffer from poor healthcare access and educational disparities that contribute to different health outcomes, including hypertension management.^[3][4]

Numerous studies have identified a range of factors associated with hypertension that include, but are not limited to, age, gender, economic status, lifestyle choices (such as dietary habits, alcohol consumption, and physical activity), and genetic predisposition. The evolving demographic patterns, dietary habits, and healthcare access issues further complicate the epidemiology of hypertension, making it crucial to conduct region-specific studies to address these variances effectively.^[5][6]

Aim

To compare the prevalence of hypertension and identify associated risk factors in urban and rural populations.

Objectives

1. To determine and compare the prevalence of hypertension in urban and rural settings.
2. To identify and analyze lifestyle and dietary factors associated with hypertension in these populations.
3. To evaluate the impact of healthcare accessibility on hypertension management in urban versus rural communities.

Source of Data

The data for this cross-sectional study were collected from health records obtained from local healthcare facilities and direct surveys conducted in selected urban and rural areas.

Study Design

A cross-sectional study design was used to assess the prevalence of hypertension and its associated risk factors.

Study Location

The study was conducted in both urban and rural regions within the state of Maharashtra, India.

Study Duration

The data collection phase of the study spanned from January 2024 to December 2024.

Sample Size

A total of 500 participants were included in the study, with equal representation from urban (250) and rural (250) populations.

Inclusion Criteria

Included were adults aged 18 years and above, residing in the study locations for at least one year prior to the commencement of the study.

Exclusion Criteria

Excluded were individuals with pre-existing chronic kidney diseases, pregnant women, and those unwilling to consent to participate in the study.

Procedure and Methodology

Participants were surveyed using structured questionnaires to gather information on demographic details, dietary habits, lifestyle factors, and medical history. Blood pressure measurements were taken twice using standard sphygmomanometers by trained medical personnel.

Sample Processing

Blood samples were collected to determine biochemical parameters related to hypertension risk, such as lipid profiles and glucose levels.

Statistical Methods

Data were analyzed using SPSS software. Descriptive statistics were employed to calculate the prevalence rates. Chi-square tests and logistic regression models were used to identify associations between hypertension and potential risk factors.

Data Collection

Data collection was conducted through face-to-face interviews and physical examinations in community health centers, supplemented by door-to-door visits in difficult-to-reach rural areas to ensure comprehensive coverage and inclusivity.

Table 1: Prevalence of Hypertension and Associated Risk Factors

Table 1 provides a comparative analysis of hypertension prevalence and associated risk factors between urban and rural populations. The data indicate a higher prevalence of hypertension in rural areas (40.8%) compared to urban areas (34.8%), with a statistically significant difference (p=0.045). Age also shows a significant difference; the mean age in rural areas is higher (50.4 ± 13.6) than in urban areas (46.7 ± 12.3), with a p-value of 0.037. Body Mass Index (BMI) is another significant factor, with rural populations showing a higher mean BMI (29.3 ± 5.1) than their urban counterparts (27.9 ± 4.5), and the difference is statistically significant (p=0.012). Smoking habits and family history of hypertension also differ significantly between the two groups, with rural populations showing higher percentages in both categories (p-values of 0.018 and 0.034, respectively).

Table 2: Prevalence of Hypertension in Urban and Rural Settings

Table 2 focuses solely on the prevalence of hypertension, reiterating that rural areas have a significantly higher rate (40.8%) compared to urban areas (34.8%), with a p-value of 0.045. This table emphasizes the disparity in health outcomes between urban and rural settings.

Table 3: Lifestyle and Dietary Factors Associated with Hypertension

Table 3 explores lifestyle and dietary factors associated with hypertension. Rural residents consume more daily servings of vegetables (3.8 ± 1.4) than urban residents (2.3 ± 1.1), with a highly significant difference in mean intake (p<0.001). Physical activity levels are higher in urban areas (63.6%) compared to rural areas (52.4%), with a significant p-value of 0.019. Alcohol consumption is higher in urban areas (30.0%) than in rural areas (23.2%), also with a significant difference (p=0.046). Furthermore, salt intake is significantly higher in rural areas (10.6 ± 2.3 g/day) compared to urban areas (8.4 ± 2.1 g/day), with the differences being statistically significant (p<0.001).

Table 4: Impact of Healthcare Accessibility on Hypertension Management

Table 4 details the impact of healthcare accessibility on hypertension management. It highlights significant disparities in healthcare access, with urban populations faring better across all metrics. A higher percentage of urban residents have access to healthcare (92.0% vs. 74.8%, p<0.001), attend regular health checkups (76.0% vs. 56.8%, p<0.001), participate in awareness programs (82.0% vs. 67.2%, p=0.001), and have availability of blood pressure monitoring (97.2% vs. 88.4%, p=0.005) compared to their rural counterparts. This table underscores the challenges faced by rural populations in accessing adequate healthcare resources for hypertension management.

Table 1: Prevalence of Hypertension and Associated Risk Factors

This study found a higher prevalence of hypertension in rural populations (40.8%) compared to urban populations (34.8%), which aligns with findings from other studies that suggest a complex interaction of lifestyle, access to healthcare, and socioeconomic factors influencing hypertension rates. Wang J et al.(2018)^[7] found varying rates of hypertension globally, influenced heavily by urbanization and lifestyle factors. The difference in mean ages and BMI between urban and rural residents also supports literature suggesting that older age and higher BMI are significant predictors of hypertension Islam SM et al.(2015)^[8].

The higher rates of smoking and family history of hypertension in rural areas are notable and align with research by Rahman M et al.(2018)^[9], who found similar trends in rural populations in developing regions, possibly due to less awareness and poorer health education.

Table 2: Prevalence of Hypertension in Urban and Rural Settings

The direct comparison of hypertension prevalence between urban and rural settings further highlights the disparity noted above. This dichotomy is widely supported in literature, such as the work by Kingue S et al.(2015)^[10], who report that urbanization affects lifestyle behaviors that can increase the risk of hypertension.

Table 3: Lifestyle and Dietary Factors Associated with Hypertension

Significant differences in lifestyle and dietary factors between urban and rural dwellers were noted, such as daily vegetable intake, physical activity, alcohol consumption, and salt intake. These findings are consistent with studies like those by Li J et al.(2017)^[11], which have linked dietary habits and physical inactivity to higher hypertension rates. The high salt intake in rural areas particularly mirrors global concerns about dietary contributions to hypertension Kishore J et al.(2016)^[12].

Table 4: Impact of Healthcare Accessibility on Hypertension Management

The stark differences in healthcare accessibility and management of hypertension between urban and rural areas underscore systemic issues. Urban areas have better access to healthcare services, regular health checkups, and health awareness programs, which is supported by Singh S et al.(2017)^[13], who emphasize the role of healthcare access in managing non-communicable diseases like hypertension.

This cross-sectional study provided a comprehensive examination of the prevalence of hypertension and its associated risk factors within urban and rural populations. Our findings reveal a notable disparity in the prevalence rates of hypertension, with rural populations exhibiting a significantly higher prevalence (40.8%) compared to their urban counterparts (34.8%). These differences are likely influenced by a range of socio-demographic and lifestyle factors, including higher BMI, older average age, greater incidences of smoking, and a stronger familial history of hypertension in rural areas.

Additionally, the study highlighted significant lifestyle and dietary differences between the two populations. Rural residents, despite consuming more vegetables, also had higher salt intake and lower levels of physical activity, factors that are strongly associated with increased blood pressure and the risk of developing hypertension. Urban residents, while better in terms of some lifestyle practices, still showed substantial room for improvement, especially in alcohol consumption and physical activity levels.

Furthermore, the impact of healthcare accessibility on the management of hypertension cannot be overstated. Urban areas demonstrated significantly better healthcare access, more frequent health check-ups, higher participation in health awareness programs, and greater availability of blood pressure monitoring facilities compared to rural areas. This disparity in healthcare access and utilization underscores the need for targeted health policies aimed at improving healthcare infrastructure and educational programs in rural areas to manage and mitigate the risks associated with hypertension.

Overall, this study underscores the complex interplay of genetic, environmental, and social factors in the epidemiology of hypertension. It calls for a multifaceted approach to healthcare delivery that considers these diverse factors, aiming to reduce the burden of hypertension through tailored public health strategies and interventions that address both urban and rural needs.

LIMITATIONS OF STUDY

1. Cross-Sectional Design: The inherent nature of a cross-sectional study limits our ability to establish causality between hypertension and its associated risk factors. This type of study only provides a snapshot in time, which is ideal for identifying associations but not for determining the directionality or causality of these relationships.
2. Selection Bias: Although efforts were made to randomly select participants, the potential for selection bias cannot be entirely ruled out. The participants volunteering for the study might not be perfectly representative of the general urban and rural populations, possibly skewing the prevalence rates and the perceived impact of risk factors.
3. Self-Reported Data: A significant portion of the data, particularly regarding lifestyle factors such as diet, physical activity, and smoking habits, was self-reported. This method is susceptible to recall bias and social desirability bias, which could lead to underreporting or overreporting of these factors, thus affecting the accuracy of the data.
4. Measurement Variability: Although standardized protocols were attempted to be used across sites for measuring blood pressure and other variables, slight variations in technique or equipment between urban and rural settings could introduce measurement bias, potentially influencing the results.
5. Geographical Limitations: The study was confined to specific urban and rural areas, which may not accurately represent all urban or rural areas nationally or globally. Therefore, the findings might not be generalizable to other regions with different socioeconomic statuses, cultural backgrounds, or healthcare systems.
6. Lack of Depth in Certain Variables: The study did not capture some potentially influential covariates, such as stress levels, detailed dietary patterns, genetic factors, and detailed socioeconomic data, which might interact significantly with hypertension risk.
7. Healthcare Access: While differences in healthcare access were noted, detailed aspects of healthcare quality, patient satisfaction, and adherence to treatment were not thoroughly evaluated, which are critical components in managing hypertension effectively.

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