High prevalence of hypertension and its association with psychological distress in urban slums in Pune, India

Hypertension prevalence in low-income populations globally is increasing rapidly and may have unique poverty-related determinants. Factors related to stress may be important contributors to hypertension in these populations in addition to traditional factors such as age and obesity. We examined stress-related and traditional hypertension risk factors among urban poor in Pune, India. We used cluster area random sampling to enroll adults aged ≥18 years from urban slum communities, collecting demographics, psychological distress (Kessler-6), tobacco use, anthropometrics, and blood pressure. Psychological distress was defined as Kessler-6 ≥11. Hypertension was defined as systolic blood pressure ≥140, diastolic blood pressure ≥90 or taking hypertension medications. We conducted multivariable logistic regression on hypertension, adjusting for age, BMI, and tobacco use. Among 502 adults, median age was 44 years (IQR 31-53), 75.5% (n=379) were female, and 72.2% (N=365) had overweight/obese BMI. Hypertension prevalence (age-standardized) was 50.4% (n=257). Psychological distress was independently associated with hypertension (aOR 2.14, 95% CI 1.23, 3.73). Age >50 years (aOR 2.75, 95% CI 1.42, 5.31), obese BMI (aOR 2.36, 95% CI 1.41, 3.94), and tobacco use at hazardous level (World Health Organization ASSIST score 4-26) (aOR 2.88, 95% CI 1.38, 6.02) were also significantly associated with hypertension. Upon sex-stratification, similar results were seen among women. We found a high prevalence of hypertension in a predominately female urban slum population in India. Hypertension was associated with stress. Public health programs for hypertension prevention in low-income populations should screen for and address stress in addition to traditional risk factors.