Hypertension and Renal Disease in the Pakistani Populat*

巴基斯坦是一个低收入发展中国家，有五个主要的种族亚群，每个亚群都有不同的语言、文化习俗、饮食习惯、健康信念和行为。1990-1994年巴基斯坦全国健康调查(NHSP)以来自2400户城市和农村家庭的18135名具有全国代表性的人为样本，强调了高血压的严重程度(45岁及以上的人占33%)，以及缺乏发现(农村地区占85%)。对NHSP数据的初步分析表明，高血压和其他心血管疾病(CVD)危险因素在种族亚群中的患病率存在显着差异。然而，这种差异的原因还没有被探究。这项建议的主要目的是探索高血压和其他心血管危险因素患病率的种族差异，高血压检测和治疗的种族差异，以及这些差异的决定因素。我们将特别关注社会人口学和临床因素作为决定因素。这项建议的具体目的是：1)确定高血压患病率的种族差异；2)确定高血压检测的种族差异；3)确定高血压以外的心血管危险因素患病率的种族差异，包括糖尿病、高胆固醇血症、蛋白尿和吸烟；4)确定全科医生检测和治疗高血压的方法。首席调查员是一名资深调查员，在高血压临床试验的二级分析方面经验丰富。联合首席调查员是卡拉奇阿加汗大学的一颗“冉冉升起的新星”。她之前曾在PI接受过培训，并在巴基斯坦建立了一支能够实现所有具体目标的研究团队。这项研究的结果将提高对高血压和其他心血管疾病危险因素的了解，并将作为制定预防计划以及进一步研究巴基斯坦这些危险条件的科学平台。

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.