Gender-specific effects of caste and salt on hypertension in poverty: a population-based study

Little is known about the risk of developing hypertension in those living in poverty in rural India. We examined gender and caste influences on risk factors for hypertension in a disadvantaged rural community.

In 1479 adults living in 12 hamlets in rural Andhra Pradesh, we measured blood pressure, height, weight, waist and hip girth, and used point-of-care devices to measure blood glucose, cholesterol, triglyceride and haemoglobin levels. Information about lifestyle habits was obtained by questionnaire. Multivariable backward stepwise logistic regression was used to determine factors associated with hypertension (blood pressure ≥ 140/90 mmHg).

The mean age was 39.7 years; 46.2% were men, 11.4% were hypertensive, 0.8% were obese and 44.4% were underweight (BMI <18.5 kg/m). Dietary salt intake was more than 40 g/day. Belonging to a forward caste was associated with a greater risk of hypertension in both men and women. The association of caste was eliminated after adjustment for BMI in women [odds ratio (OR) 1.12; 95% confidence interval (CI) 0.61-2.06], but not in men (OR 2.93, 95% CI 1.77-4.86). Similar results were found for educational status. High salt intake was not associated with hypertension in women (OR 0.85, 95% CI 0.44-1.65), but was in men (OR 2.26, 95% CI 1.27-4.02).

In this disadvantaged rural community, men are particularly prone to the effects of relative socioeconomic advantage and salt intake on the risk of hypertension. Traditional risk factors may play a greater role in the development of hypertension in men living in poverty than in women.