Relation of high blood pressure to glucose intolerance, plasma lipids and educational status in an Arabian Gulf population

Abstract

Background. In Bahrain and other populations of the Arabian Peninsula, glucose intolerance is associated with raised plasma total cholesterol, postmenopausal status and low educational status. These associations are not generally seen in other populations with high diabetes prevalence. A study was undertaken in order to determine if hypertension in Bahrainis is associated with the same factors as those related to glucose intolerance. Methods. A cross-sectional survey of 2120 Bahrainis aged 40-69 years. Results. The age-adjusted prevalence of hypertension (defined as current treatment for hypertension, systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 95 mmHg) rose with increasing degrees of glucose intolerance. Age- and sex-standardized prevalence of hypertension was 21% (95% CI: 19-24%) in those with normal glucose tolerance, 31% (95% CI: 27-36%) in those with impaired glucose tolerance, and 38% (95% CI: 34-42%) in those with diabetes. In a multivariate analysis adjusting for age and sex, raised blood pressure was independently associated with waist girth, plasma cholesterol, glucose intolerance, family history of hypertension and (in women) postmenopausal status. There was an inverse relationship between blood pressure and educational status that was independent of other variables. This association parallels the inverse relationship of diabetes to educational level and is consistent with low educational level being a marker for socioeconomic deprivation in early life in this population. Conclusion. The high prevalence rates of hypertension and diabetes in Bahrainis are manifestations of a pattern of metabolic disturbances that includes raised plasma cholesterol levels. Both hypertension and diabetes are associated with low educational status, which in this population is a marker for socioeconomic deprivation in early life. This suggests that the risk of hypertension may be set by environmental factors in early life.