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Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population

Malekzadeh, Masoud M.a,*; Etemadi, Arasha,b,*; Kamangar, Farina,c; Khademi, Hoomana,d; Golozar, Asieha,b; Islami, Farhada,e; Pourshams, Akrama; Poustchi, Hosseina; Navabakhsh, Behrouza; Naemi, Mohammadf; Pharoah, Paul D.g; Abnet, Christian C.b; Brennan, Paulc; Boffetta, Paoloe,h; Dawsey, Sanford M.b; Esteghamati, Alirezai; Malekzadeh, Rezaa

doi: 10.1097/HJH.0b013e3283613053

Background: There is considerable variation in hypertension prevalence and awareness, and their correlates, across different geographic locations and ethnic groups. We performed this cross-sectional analysis on data from the Golestan Cohort Study (GCS).

Methods: Enrollment in this study occurred in 2004–2008, and included 50 045 healthy individuals from Golestan Province in northeastern Iran. Hypertension was defined as a SBP at least 140 mmHg, a DBP at least 90 mmHg, a prior diagnosis of hypertension, or the use of antihypertensive drugs. Potential correlates of hypertension and its awareness were analyzed by logistic regression adjusted for sex, age, BMI, place of residence, literacy, ethnicity, physical activity, smoking, black and green tea consumption and wealth score.

Results: Of the total cohort participants, 21 350 (42.7%) were hypertensive. Age-standardized prevalence of hypertension, using the 2001 WHO standard world population, was 41.8% (95% confidence interval: 38.3–45.2%). Hypertension was directly associated with female sex, increased BMI, Turkmen ethnicity, and lack of physical activity, and inversely associated with drinking black tea and wealth score. Among hypertensive patients, 46.2% were aware of their disease, 17.6% were receiving antihypertensive medication, and 32.1% of the treated patients had controlled hypertension. Hypertension awareness was greater among women, the elderly, overweight and obese patients, and those with a higher wealth score.

Conclusion: Hypertension is highly prevalent in rural Iran, many of the affected individuals are unaware of their disease, and the rate of control by antihypertensive medications is low. Increasing hypertension awareness and access to health services, especially among less privileged residents are recommended.

aDigestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

bDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda

cDepartment of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA

dInternational Agency for Research on Cancer, Lyon, France

eThe Tisch Cancer Institute, Mount Sinai School of Medicine and Institute for Translational Epidemiology, New York, New York, USA

fDepartment of Internal Medicine, School of Medicine, Gorgan University of Medical Sciences, Gorgan, Iran

gDepartments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, UK

hInternational Prevention Research Institute, Lyon, France

iEndocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

*Masoud M. Malekzadeh and Arash Etemadi contributed equally to the writing of this article.

Correspondence to Arash Etemadi, MD, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20852, USA. Tel: +1 301 4964378; fax: +1 301 4966829; e-mail:

Abbreviations: CVA, cerebrovascular accidents; CVD, cardiovascular disease; FFQ, food frequency questionnaire; GCS, Golestan Cohort Study; NHANES, National Health and Nutrition Examination Survey; NO, nitric oxide; SES, socioeconomic status

Received 3 December, 2012

Revised 6 February, 2013

Accepted 13 March, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins