Prevalence of hypertension and its risk factors in a rural village of district Raigad in Maharashtra: a community-based cross-sectional study

INTRODUCTION

Hypertension remains a major preventable risk factor contributing to cardiovascular diseases, stroke and chronic kidney disease worldwide. It affects an estimated 1.3 billion adults aged 30–79 years and elevated blood pressure is responsible for nearly 10 million deaths each year. Despite the availability of effective treatment, a large proportion of individuals with hypertension remain undiagnosed and blood pressure control is still inadequate in many settings.¹ India is currently experiencing an epidemiological shift marked by a growing burden of non-communicable diseases.

Although hypertension was once regarded primarily as a problem of urban and higher socioeconomic populations, recent evidence indicates a substantial rise in rural areas as well. This trend is likely driven by dietary changes, tobacco consumption, sedentary lifestyles and increasing life expectancy.^2,3 A recent systematic review estimated the pooled prevalence of hypertension in rural India to be around 27%, highlighting the magnitude of the problem.² In Maharashtra, one of India’s largest states, the prevalence of hypertension is estimated to be nearly 25%, with wide variation across regions and population groups.⁴ However, awareness, treatment and control levels remain unsatisfactory, particularly in rural and tribal communities.⁵ District-specific evidence from Raigad remains limited, despite its mix of rural and tribal populations undergoing rapid socioeconomic and lifestyle transitions.

India has set national goals to reduce mortality from non-communicable diseases, making early detection and control of hypertension through primary healthcare services a key public health priority.⁶

In this context, reliable local data are essential for planning targeted interventions. Therefore, the present study was conducted to determine the prevalence of hypertension and identify associated risk factors among adults aged ≥30 years in a rural village of Raigad district.

Objectives

To estimate the prevalence of hypertension among adults aged ≥30 years. To identify sociodemographic, anthropometric and lifestyle-related risk factors associated with hypertension.

METHODS

Study design and setting

A community-based cross-sectional study was conducted between December 2022 and July 2023 in Poyanje (rural) and Poyanje-wadi (tribal), located in Panvel Taluka of Raigad district, Maharashtra.

Study population

Adults aged 30 years and above residing in the study area for at least one year were eligible. Pregnant women and individuals unable to provide informed consent were excluded.

Sample size

Sample size was calculated using Epi Info software assuming an expected prevalence of 25%, confidence level: 95%, margin of error: 5%. The minimum calculated sample size was 288. After accounting for non-response, 302 participants were included.

Sampling technique

A list of households was obtained from Gram Panchayat records. Simple random sampling was used to select households. All eligible adults in selected households were included. A total of 395 households were visited.

Operational definitions

Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or current use of antihypertensive medication.¹

Overweight and obesity were defined using standard BMI cut-offs. Central obesity was assessed using waist circumference criteria appropriate for Asian populations. Smoking was defined as current use of tobacco in smoked form. Alcohol consumption was defined as intake within the last 30 days.

Data collection

Data were collected using a structured, pre-tested questionnaire in Marathi. Information included age, sex, education, occupation, tobacco and alcohol use, dietary habits, physical activity, history of hypertension and other NCDs.

Weight was measured using a digital weighing scale, height using a stadiometer and waist circumference using a non-stretchable tape. Blood pressure was measured using a validated digital sphygmomanometer. Three readings were taken at 10-minute intervals after at least five minutes of rest and the average was recorded before measurement.

Statistical analysis

Data were analysed using STATA software. Continuous variables were expressed as mean±standard deviation. Categorical variables were expressed as frequencies and percentages.

Bivariate associations were assessed using the Chi-square test. Variables with p<0.20 were included in multivariate logistic regression. Adjusted odds ratios (AOR) with 95% confidence intervals were calculated. Statistical significance was set at p<0.05.

Ethical considerations

Ethical approval was obtained from the Institutional Ethics Committee (IEC No: NIPHTR/2022-23). Verbal informed consent was obtained from all participants.

RESULTS

A total of 302 participants were included in the study. The mean age of the participants was 50±13.1 years, with equal representation of males and females (151 each; 50.0%).

Among the participants, the largest age group was 30–44 years (38.1%), followed by 45–59 years (34.4%) and ≥60 years (27.5%). Most participants belonged to lower socioeconomic classes, with 39.4% in Class V and 37.4% in Class IV. Regarding education, 36.1% had secondary education, while 34.1% had higher secondary education and above. Smoking was reported by 12.6% of participants, tobacco use by 23.8% and alcohol consumption by 13.2%. Based on BMI classification, 56.3% had normal BMI, 18.9% were overweight and 4.3% were obese.

Abnormal waist circumference was present in 30.8% of participants. The overall prevalence of hypertension was 29.8% (90/302). Of the total participants, 19.5% were newly diagnosed hypertensives, while 10.3% were previously known cases. The prevalence of hypertension increased significantly with age (p=0.003).

In multivariable logistic regression analysis, participants aged 45–59 years had 2.25 times higher odds of hypertension (95% CI: 1.03–4.94; p=0.042), while those aged ≥60 years had 7.11 times higher odds (95% CI: 3.01–16.82; p<0.001). Very high waist circumference (AOR 3.16; 95% CI: 1.15–8.71; p=0.026), NCD risk score ≥2 (AOR 3.11; 95% CI: 1.13–8.58; p=0.028) and smoking (AOR 3.83; 95% CI: 1.45–10.12; p=0.007) were also independently associated with hypertension.

DISCUSSION

The present community-based cross-sectional study found a hypertension prevalence of 29.8%, which is comparable to pooled estimates reported for rural India (around 27%) and similar to findings from studies conducted in rural Maharashtra and other parts of India.^2,4 This indicates that hypertension is no longer confined to urban populations and reflects the ongoing epidemiological and lifestyle transition in rural communities. Age emerged as the strongest independent predictor of hypertension in the present study. Participants aged 45–59 years and ≥60 years had significantly higher odds of hypertension compared with younger adults. Similar associations between increasing age and hypertension have been consistently reported in previous Indian studies and national surveys.^3,5 The observed age gradient may be explained by progressive arterial stiffness, endothelial dysfunction and cumulative exposure to cardiovascular risk factors with advancing age.

Central obesity, reflected by very high waist circumference, was independently associated with hypertension. This finding is consistent with previous epidemiological studies showing that abdominal adiposity is a stronger predictor of raised blood pressure than BMI alone.^6,7 Excess visceral fat contributes to insulin resistance, chronic inflammation and sympathetic overactivity, thereby increasing vascular resistance and blood pressure. Smoking was another significant determinant in the present study, with smokers showing nearly fourfold higher odds of hypertension. Similar findings have been documented in earlier rural and community-based studies in India.⁸ Nicotine-induced vasoconstriction, increased arterial stiffness and sympathetic stimulation may explain this association. The finding that 19.5% participants were newly diagnosed hypertensives highlights substantial gaps in awareness and routine screening coverage. This is particularly relevant for strengthening NPCDCS and primary healthcare-based opportunistic screening in rural populations.

This study has certain limitations. The cross-sectional design limits causal inference between risk factors and hypertension. Blood pressure was measured during a single visit, which may have introduced measurement variation despite using the average of three readings. Behavioural variables such as tobacco and alcohol use were self-reported, making them susceptible to recall and social desirability bias. However, the community-based design, random sampling and standardized measurement procedures strengthen the validity of the findings.

CONCLUSION

Hypertension prevalence was high in this rural population. Advancing age, central obesity, clustering of NCD risk factors and smoking were independently associated with hypertension. Strengthening community-based screening, early detection and lifestyle modification strategies should be prioritized.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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