BMI, Waist to Height Ratio and Waist Circumference as a screening tool for Hypertension in Hospital out Patients: A Cross-Sectional, Non-inferiority study
BackgroundObesity has become a global epidemic and an important risk factor for non-communicable diseases. Earlier thought to be a problem in the developed world, it has become a problem in low-and middle-income countries, including Nepal. In the absence of routine surveillance or a registry system, the actual burden and trend of obesity in Nepal is unknown. Obesity and overweight are recognized as risk factors for hypertension and associated with cardiovascular diseases. The study aimed to
... out the burden of obesity, using three commonly employed metrics in the hospital outpatient setting of a developing country as predictors of hypertension, and compare the ability of different anthropometric measurements through a non-inferiority study to predict hypertension.MethodsThis cross-sectional study was conducted among 40-69 years outpatients in a tertiary Eye, and ENT hospital in a semi-urban area of Nepal among randomly selected 2,256 participants from 6,769 outpatients evaluated in Health Promotion and Risk Factor Screening Service. We did a correlation analysis to determine the relationship between anthropometric measurement and blood pressure. The area under the Receiver Operating Characteristic curve of Body Mass Index (BMI), Waist to Height Ratio (WHtR), and Waist Circumference (WC) was calculated and compared.ResultsThe prevalence of obesity and overweight by BMI was 16.09% and 42.20%, respectively; by WHtR was 32.76%, which is two times higher than obesity measured by BMI. High WC was observed among 66.76% of participants. Female participants had a greater prevalence of high WC (77.46%) than males (53.73%) (p<0.001). Prevalence of hypertension and pre-hypertension was 40.67% and 36.77%, respectively. The areas under the curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602), and WC (0.610).ConclusionWC correlated well with obesity and hypertension. It also had a higher predicting ability than WHtR and BMI to predict hypertension. WC thus proved to be non-inferior to two other commonly used metrics. It proved superior in detecting obesity in female. This inexpensive and simple non-tension tape measurement may play an important role in future diagnosis of obesity and prediction of HTN in resource-constrained settings of developing countries.