Socioeconomic Differentials in Hypertension based on JNC7 and ACC/AHA 2017 Guidelines Mediated by Body Mass Index: Evidence from Nepal Demographic and Health Survey

Background Unlike developed countries; higher socioeconomic status (SES, education, and wealth) is associated with hypertension in low and middle-income countries (LMICs) with limited evidence. We examined the associations between SES and hypertension in Nepal and the extent to which these associations vary by sex and urbanity. The body mass index (BMI) was examined as a secondary outcome and assessed as a potential mediator. Materials and methods We analyzed the latest Nepal Demographic and Health Survey data (N=13,436) collected between June 2016 and January 2017, using a multistage stratified sampling technique. Participants aged 15 years or older from selected households were interviewed with an overall response rate of 97%. Main outcomes were hypertension and normal blood pressure defined by the widely used Seventh Report of the Joint National Committee (JNC 7), and the American College of Cardiology/American Heart Association (ACC/AHA) 2017. Results The prevalence of hypertension was higher in Nepalese men than women. The likelihood of having hypertension was more than double for individuals in the highest versus lowest wealth quintiles [men: OR 2.13, 95% CI 1.60-2.85); women: OR 2.54, 95% CI 2.00- 3.24] and for individuals with the higher education versus no education [men: OR 2.38, 95% CI 1.75-3.23; women: OR 1.63, 95% CI 1.18-2.25]. The associations between SES and hypertension were different by sex and urbanity. These associations were mediated by BMI. Conclusions Higher SES was positively associated with the higher likelihood of having hypertension in Nepal according to both JNC 7 and ACC/AHA 2017 guidelines. These associations were mediated by BMI, which may help to explain broader socioeconomic differentials in CVD and related risk factors, particularly in terms of education and wealth. Our study suggests that the mediating factor of BMI should be tackled to diminish the risk of CVD in people with higher SES in LMICs.