Seasonal Variation in Blood Pressure and Hypertension: A Study of the Indian National Family Health Survey IV Open Access

Hayes, Madison (Spring 2020)

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Background: Although evidence suggests that blood pressure varies seasonally, seasonal effects on blood pressure have not been well described in countries with tropical climates such as India. We examined the cross-sectional association of season of measurement with blood pressure and hypertension in a nationally representative study of Indian adults.

Methods: Using the 2015-16 Indian National Family and Health Survey IV, we analyzed systolic and diastolic blood pressure (SPB and DBP, respectively) measurements of 596,052 men aged 15-54 and women aged 15-49 by season of measurement. Mean SBP and DBP and prevalence of hypertension (taking blood pressure control medication, SBP ≥ 140 mmHg, or DBP ≥ 90 mmHg) were described in the total population and by sex, rurality, age group, and weight status. Multiple linear regression models estimated mean differences in SBP and DBP, while multiple logistic regression models estimated the odds ratios (OR) of hypertension, by season. Adjusted models accounted for demographic and social factors, and blood-pressure altering behaviors at the time of measurement.

Results: Mean SBP and DBP were 112.85 (112.78, 112.93) and 76.0 (75.95, 76.05) for women and 112.85 (119.81, 120.11) and 78.83 (78.71, 78.96) for men, respectively. In adjusted analyses, SBP, DBP, and hypertension were statistically significantly lower in pre-monsoon, monsoon, and post-monsoon as compared to winter. Nationally, mean SBP in pre-monsoon was -1.95 mmHg (-1.96, -1.95) compared with winter SBP, the largest seasonal difference observed. DBP was similarly lower in pre-monsoon season and monsoon season compared with winter (-2.10 mmHg [-2.11, -2.10]; and -2.13 mmHg [-2.13, -2.12], respectively). Relative to winter, the odds of hypertension were lowest in the monsoon season (OR=0.53 [0.53, 0.58]). Seasonal differences in blood pressure were larger in rural as compared with the urban population.

Conclusion: To our knowledge, this is the first study to utilize nationally representative data to assess the association between season of measurement and blood pressure outcomes in India. On average, SBP, DBP, and hypertension were lower in pre-monsoon, post-monsoon, and monsoon seasons compared to winter. Clinical management and epidemiologic studies of blood pressure may be improved by taking into account seasonality.  

Table of Contents

Table of Contents

Chapter I: Literature Review.. 1

Burden of Hypertension. 1

Impact of Season on Blood Pressure Levels. 1

Seasonality and Blood Pressure Outcomes in India. 2

Existing Research of Blood Pressure and Hypertension Variation in Non-Temperate Countries. 3

Knowledge Gap. 5

Study Objectives. 5

References. 7

Chapter II: Manuscript 10

Abstract 10

Key Messages. 11

Introduction. 11

Methods. 13

Results. 15

Discussion. 17

References. 22

Tables. 25

Chapter III: Summary, Public Health Implications, and Possible Future Directions. 38

Summary. 38

Public Health Implications. 38

Possible Future Directions. 39

References. 40

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