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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 70-75

Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State


1 Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
2 Department of Medicine, Alex Ekwueme Federal Teaching Hospital, Abakaliki, Nigeria
3 Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria

Date of Submission15-Jun-2020
Date of Acceptance28-Aug-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Paschal O Njoku
Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_42_20

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  Abstract 

Background: Hypertension is a major contributor to the global burden of disease and global mortality, with a projection of 39.1 million cases in Nigeria by the year 2030. Aim: The aim of this study was to evaluate the effect of body mass index on blood pressure (BP) and blood glucose in three rural agrarian communities in Enugu State, Nigeria. Materials and Methods: This was an opportunistic cross-sectional study in three rural agrarian communities––Ibagwa, Akpugo, and Egede, all in Enugu State. Volunteer adults of 18 years and above were consecutively recruited and screened. Omron BP monitors were used mostly and supplemented by mercury BP sphygmomanometers. Each participant had their BP measured after at least 5 min of rest, and repeated twice after 3–5 min interval and also received a questionnaire about demographics, lifestyle, and environmental factors. Hypertension was defined as a systolic BP equal to or more than 140mm Hg and/or diastolic BP equal to or more than 90mm Hg or in those on treatment for hypertension. Ethical approval was obtained and all participants gave informed consent before screening. Data were collated and analyzed. Result: People of middle (40–64 years) and elderly (>65 years) age groups constituted the majority of participants. Most of the participants in the three groups had normal body mass index. The proportion of participants with hypertension was 15.2%, 21.9%, and 31.9% for Ibagwa, Akpugo, and Egede communities, respectively. The mean BMI was 27.08 kg/m2, 24.70 kg/m2 and 24.45 kg/m2 for participants from Ibagwa, Egede, and Akpugo communities, respectively. Prevalence of overweight and obesity was higher among Ibagwa people, whereas the prevalence of underweight was higher among Egede people (P < 0.001). Conclusion: Low proportion of participants had hypertension in the three communities and rising age was more associated with hypertension than overweight and obesity.

Keywords: Agrarian, body mass index, diabetes mellitus, hypertension


How to cite this article:
Njoku PO, Onwubere BJ, Mbadiwe NC, Ejim EC, Anisiuba BC, Iyidobi TC, Okonkwo AK. Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State. Int J Med Health Dev 2021;26:70-5

How to cite this URL:
Njoku PO, Onwubere BJ, Mbadiwe NC, Ejim EC, Anisiuba BC, Iyidobi TC, Okonkwo AK. Effects of age and body mass index on blood pressure and blood glucose in three rural agrarian communities in Enugu State. Int J Med Health Dev [serial online] 2021 [cited 2021 Jan 20];26:70-5. Available from: https://www.ijmhdev.com/text.asp?2021/26/1/70/298785




  Introduction Top


Hypertension is a major global public health problem.[1] It has been reported as threat to the health of people in sub-Saharan Africa (SSA), being a major contributor to morbidity and mortality in the sub-region.[2],[3],[4],[5] The overall prevalence of hypertension in Nigeria ranges between 8% and 46.4%[6] with reported differences in urban and rural areas.[7],[8],[9],[10],[11],[12] Increased physical activities and consumption of predominantly unprocessed food are believed to reduce weight gain, prevalence of cardio-metabolic syndrome and hypertension in African agrarian communities.[7],[13],[14] This study evaluated the body mass index (BMI), blood pressure (BP), and blood glucose of adults in three rural agrarian communities in Enugu State.


  Materials and Methods Top


Study area

Nigeria is made up of six geopolitical zones with a total of 36 states and the Federal Capital Territory. The South East zone is located between latitude 5°–7° North of the Equator and longitude 6°–8° East Greenwich, and populated by estimated 30 million Igbo speaking people distributed in five states (Abia, Anambra, Ebonyi, Enugu, and Imo).

The study took place in Ibagwa Nike, Enugu East Local Government Area (LGA); Egede in Udi LGA; and Akpugo in Nkanu East LGA, all in Enugu State. These are rural areas whose inhabitants are predominantly of the middle and elderly age groups, actively engaged in agriculture and producing vegetables, palm produce, yam, cassava, rice, and other economic crops. Their staple food is mostly vegetables and fruits, yam, locally processed cassava, and rice.

Study design

The Study Personnel were Investigators and Volunteers made up of Doctors, Nurses, Medical students, Social Welfare workers, and Laboratory Technologists drawn from the Cardio-Thoracic Unit of the National Cardiothoracic Centre of Excellence, University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu.

Training of personnel was conducted using the training materials supplied by International Society of Hypertension (ISH) and coordinated by the Nigerian Hypertension Society as part of the May Measurement Month project 17. It was an opportunistic cross-sectional survey of participants who were 18 years and above, and this was commenced in the month of May 2017.

Screenings were conducted in public places after a session of public messages. Basic clinical and demographic data were captured using a questionnaire.[15] Ethical approval was obtained and all participants gave informed consent before screening. Height and weight measurements were taken with the subjects in light clothing without shoes, caps or head tie on using a standard calibrated meter rule affixed to a wall perpendicular to a flat smooth surface floor, whereas the body weight was measured using a digital weighing scale (Seca, Harmburg, Germany). The BMI of Quetelet was calculated using weight in kilogram divided by the square of the height in meter. The BMI was classified using the WHO classification of BMI.[16]

Random blood glucose was checked with capillary blood using a glucometer (Acucheck). Omron digital BP monitors (Omron M3 Intellisense) were used mostly and supplemented by mercury BP sphygmomanometers. Three seated BP and heart rate recordings were taken on the left arm (preferably) after at least 5 min rest, and subsequently at 3–5 min intervals. Hypertension was defined as a systolic BP ≥140mm Hg and/ or diastolic BP ≥90mm Hg, or on the basis of receiving antihypertensive medication. Hypertension was classified according to the WHO/ISH guidelines thus: (i) mild: SBP 140–159mm Hg and/or DBP 90–99mm Hg; (ii) moderate: SBP 160–179mm Hg and/or DBP 100–109mm Hg; and (iii) severe: SBP ≥ 180mm Hg and/or DBP ≥ 110mm Hg.[17]

Data handling and statistical analysis

Data from three communities were cleaned up. Using only those individuals with all three readings, we compared mean BPs and the proportion of participants with hypertension using different combinations of the three readings.

The Statistical Package for Social Sciences version 23.0 statistical software was used for data analysis (SSPS, Chicago, Illinois). For continuous variables, mean values and standard deviations were calculated and the means compared using ANOVA or two-sample t test. Categorical variables were compared using the nonparametric tests––chi-squares. The cross-tabulation was used to analyze the relationship between the BMI, grades of BP (SBP and DBP), and sex in the respondents. Pearson’s correlation for parametric and Spearman’ rho correlation for non-parametric data were used to assess the relationship between age, BP (SBP and DBP), and anthropometric data in respondents. Significant variables were further analyzed using the stepwise method of multiple linear regression analysis to isolate predictors of SBP and DBP.

All tests were two-tailed with P < 0.05 taken as statistically significant


  Results Top


More females than males participated in the study in the three communities [Table 1]. Mean of ages of participants were 47.3 years for Ibagwa, 50.3 years for Akpugo, and 60.8 years for Egede communities.
Table 1: Sex, Age, BMI and proportions of participants with Hypertension and DM in the three communities

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Percentages of participants receiving antihypertensive medication were 17.0% for Ibagwa, 25.9% for Egede, and 15.6% for Akpugo communities. The mean systolic and diastolic BP after excluding those on treatment, were significantly higher among people of Egede community, followed by Akpugo and Ibagwa communities, respectively (P < 0.05) [Table 2]. Systolic hypertension was found in 21.4%, 51.2%, and 40% of people in Ibagwa, Egede and Akpugo communities, respectively, whereas diastolic hypertension was found in 24.1%, 35% and 24.4% of people in Ibagwa, Egede and Akpugo communities, respectively [Table 3]. Both systolic and diastolic hypertension was found in 15.2%, 31.9%, and 21.9% of people from Ibagwa, Egede and Akpugo communities. Among people from Ibagwa community, age was significantly associated with systolic BP (P = 0.014) [Table 4].
Table 2: Characteristics of the study populations

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Table 3: Proportion of participants and their systolic and diastolic blood pressure ranges in the three communities

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Table 4: Sex, Age and BMI of participants in Ibagwa community

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Current history of smoking was found in 7.1% in Ibagwa, 11.4% in Egede, and 1.9% in Akpugo participants [Table 1].

Participants with previous diagnosis of Type II diabetes was reported in 8.9% of Ibagwa, 4.8% of Egede and 2.5% of Akpugo communities, whereas random blood glucose done showed deranged values in diabetic range in 6.3% of Ibagwa, 1.3% of Akpugo and 4.2% of Egede communities.

The mean BMI was 27.08kg/m2, 24.70kg/m2 and 24.45kg/m2 for participants from Ibagwa, Egede, and Akpugo communities, respectively. Prevalence of overweight and obesity was higher among Ibagwa people, whereas the prevalence of underweight was higher among Egede people (P < 0.001) [Table 1].


  Discussion Top


More female participants were seen in the three rural agrarian communities. This could be because most of the able bodied men were in the farms working during the time of the visit for the study. People aged 40 years and above were predominantly seen in the three communities, whereas people aged <40 years were found most in Ibagwa community [Table 1]. This could be a reflection of the rural-urban drift which affects younger population in developing countries.

The proportions of participants with hypertension in the three communities were 15.2% in Ibagwa, 21.9% in Akpugo, and 31.9% in Egede communities [Table 3]. However, the proportion of participants not on treatment for hypertension was 83% in Ibagwa, 84.4% in Akpugo, and 74.1% in Egede communities, respectively [Table 1]. The proportion of participants with hypertension was lower but similar to 36.2% found in 2017 May Measurement Month[18] nationwide opportunistic screening in both rural and urban areas in Nigeria. The low treatment level in also similar to the Nigerian national survey in the same period.[18] Similar low proportions of hypertensive patients have been reported in related studies in rural communities in Nigeria[6],[7],[9],[10],[19] and Africa.[20],[21],[22],[23] The low proportion of people with hypertension in the rural and agrarian communities could be due to their staple food which consists largely of high fiber containing fresh green leafy vegetables, fruits, whole grains, tubers, and moderate protein. There is reduced consumption of processed food and drinks that contain high loads of salt, simple sugars, and fats.[7],[24],[25],[26] People from Egede community had highest proportion of people with both systolic and diastolic BP, followed by Akpugo and Ibagwa in that order (P < 0.05) [Table 2]. However, among those with hypertension, proportion of people with systolic hypertension was highest among the Egede community, followed by Akpugo and Ibagwa in that order (P < 0.001) [Table 3], probably because of the higher percentage of participants aged 41 years and above (84.9%) [Table 1], which is also shown by their higher mean age (60.81 years) [Table 2].

Proportions of people with overweight and obesity were more in Ibagwa community, whereas that of underweight was higher among Egede people (P < 0.001) [Table 1]. Irrespective of this, the mean systolic and diastolic BPs as well as the proportion of participants with systolic hypertension were highest in Egede compared to other communities probably because of the same reason given in the paragraph above. However, within Ibagwa community, age was associated with systolic hypertension (P = 0.014) [Table 4]. This shows stronger effect of aging compared to overweight and obesity on BP in this study. Similar effect of age and weight on BP has been shown in similar studies.[15],[27] There were low proportions of tobacco smokers and people with diabetes in the three communities which most likely resulted in lack of relationship with BP [Table 1]. Although the proportions of people with diabetes were low in the communities, the proportions of people with diabetes was highest in Ibagwa community possibly due to higher proportion of participants whose BMI were classified as overweight, obesity and morbid obesity [Table 1].

Limitation of the study

Being an opportunistic study there were chances of some false positive diagnosis and true prevalence cannot be ascertained.


  Conclusion Top


There was low proportion of participants with hypertension in the three agrarian communities. Rising age was associated more with hypertension than overweight and obesity. There were low proportions of tobacco users and people with diabetes mellitus in the communities.

Acknowledgement

We thank the staff of the National Cardio Thoracic Centre of Excellence, University of Nigeria Teaching Hospital Ituku-Ozalla as well as the participants and community leaders in Ibagwa Nike, Enugu East Local Government Area (LGA); Egede in Udi LGA; and Akpugo in Nkanu East LGA, in Enugu State.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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