Prevalence and contributing risk factors for hypertension in urban and rural areas of Pakistan; a study from second National Diabetes Survey of Pakistan (NDSP) 2016-2017.

Aim: To assess the prevalence and its associated risk factors for hypertension in urban and rural areas of Pakistan.Methods: This study is the part of second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a large community-based epidemiological survey. Hypertension was determined for urban/rural areas of all four provinces of Pakistan. Known hypertensives were considered as individuals with self-reported history of hypertension and/or taking any antihypertensive drug and newly diagnosed hypertension is defined; as systolic blood pressure was ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Detailed information of the survey participants were obtained from the second NDSP 2016-2017 predesigned questionnaire, which has been published earlier.Results: Overall, age adjusted weighted prevalence of hypertension was 46.2%, of which 24.9% had self-reported hypertension and 21.3% were newly diagnosed hypertensive. Prevalence of hypertension in urban and rural areas was 44.3% and 46.8%, respectively. Highest weighted prevalence of hypertension was observed in Punjab 49.2% followed by Sindh 46.3%, Baluchistan 40.9%, and Khyber Pakhtunkhwa 33.3%. Hypertension was more prevalent in rural areas compared to urban areas except in Khyber Pakhtunkhwa where it was more prevalent in urban areas. Age, female gender, marital status, positive family history of hypertension, low physical activity, positive family history of diabetes, obesity, and dyslipidemia were significantly associated with hypertension.Conclusion: This study concludes that 46.2% prevalence of hypertension is alarming in Pakistan with its associated risk factors. Hence, implementation laws with lifestyle changes and educating people are required on urgent basis to control or reduce hypertension prevalence.

Insulin-associated Weight Gain in Type 2 Diabetes and Its Relation with Caloric Intake.

Objective The aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake. Methods This retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study. Results Group B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain. Conclusion It is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.