Hypertension and Renal Disease in the Pakistani Populat*

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Pakistan is a low-income developing country with five major ethnic subpopulations, each with distinct language, cultural practices, dietary habits, health beliefs, and behaviors. The National Health Survey of Pakistan (NHSP) 1990-1994, which was based on a nationally representative sample of 18,135 individuals from 2400 urban and rural households, highlighted the magnitude of hypertension (33% of individuals age 45 years and over), and its lack of detection (85% in rural areas). Preliminary analysis of the NHSP data shows significant variations in the prevalence of hypertension and other cardiovascular disease (CVD) risk factors in the ethnic subpopulations. However, the reasons for the variations have not been explored. The main aims of this proposal are to explore the ethnic variations in prevalence of hypertension and other CVD risk factors, ethnic variation in detection and treatment of hypertension, and determinants for such variations. We will focus in particular on sociodemographic and clinical factors as determinants. The specific aims of this proposal are to: 1) Determine the ethnic variation in the prevalence of hypertension; 2) Determine the ethnic variation in detection of hypertension; 3) Determine the ethnic variations in prevalence of CVD risk factors other than hypertension, including diabetes, hypercholesterolemia, proteinuria and tobacco use; 4) Determine the approach of general practitioners toward the detection and treatment of hypertension. The Principal Investigator is a senior investigator with experience in secondary analysis of clinical trials in hypertension. The Co-Principal Investigator is a "rising star" at the Aga Khan University in Karachi. She has previously trained with the PI and has developed a research team in Pakistan capable of performing all the specific aims. The findings of this study would improve the understanding of hypertension and other CVD risk factors, and would serve as a scientific platform for development of prevention programs as well as further research into these dangerous conditions in Pakistan.