Poor diet quality and low socio-economic position (SEP) have been associated with hypertension in high income and urban populations. However, limited evidence exists for the relationship between diet, SEP and blood pressure in disadvantaged rural populations. We aimed to assess the impact of SEP and diet on hypertension in a disadvantaged rural South Indian population.Design and Method:
In a case-control study of hypertension, conducted in 58 villages in rural Andhra Pradesh, 300 cases were matched 1:1 by age and sex. Blood pressure and anthropometry were measured using a strict protocol. Sodium and potassium were measured from 24-hour urine samples. Participants were interviewed to obtain socio-demographic, lifestyle and dietary information. Conditional logistic regression was used to determine factors associated with hypertension (blood pressure ≥ 140/90 mmHg).Results:
The median age was 60 years (interquartile range 20); 56% were men. Median salt intake did not differ significantly between cases and controls (7.2 vs. 7.3 grams/day, P = 0.9). The median sodium-to-potassium ratio was greater in cases than controls (8.4 vs. 8.1, P = 0.007). In multivariable analyses, high SEP (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.4–7.7, P = 0.008) and physical inactivity (OR 3.0, 95% CI 2.0 − 4.6 P < 0.001) were associated with a greater odds of hypertension. Polygamy (OR 2.9, 95% CI 1.2–7.2, P = 0.02) and consuming alcohol (OR 2.1, 95% CI 1.2–3.8, P = 0.008) were associated with a greater odds of hypertension in men, whereas obesity (OR 2.6, P = 0.05) was associated with hypertension in women.Conclusions:
The main drivers of hypertension in this population are poor diet, SEP and lifestyle factors such as physical inactivity and consuming alcohol. Therefore strategies to improve diet quality and lifestyle behaviors may help reduce the burden of hypertension in this disadvantaged Indian population.