Christina Park, MPH, PhD(c)

Nominated From: University of Washington

Research Site: Dhulikhel Hospital/Kathmandu University

Research Area: Cardiovascular Disease

Primary Mentor: Annette Fitzpatrick

Research Project

Longitudinal risk factors and outcomes associated with blood pressure metrics in Nepal

Hypertension control remains suboptimal worldwide particularly in low- and middle-income countries (LMICs) where only 1 in 10 adults with hypertension have controlled blood pressure (BP) (1). A 2013 survey of adults in Nepal found that 90% of diagnosed hypertension was not controlled (2). Growing evidence suggests that monitoring of BP levels by community health workers may be a practical, reliable and low-cost method to improve BP control (3). However, there is limited data on longitudinal assessments of high BP and BP variability as exposures or outcomes in LMIC populations. A better understanding of risk factors, such as cardiovascular health (CVH) metrics defined by the American Heart Association (AHA) (4), and outcomes in relation to high BP and BP variability may lead to appropriate interventions that effectively lower and stabilize BP. We will leverage data from the Dhulikhel Heart Study (DHS) (5, 6), an ongoing prospective cohort study designed to collect data on cardiovascular risk factors in over 1,000 adults in central Nepal, to examine longitudinal risk factors and outcomes associated with BP metrics (e.g., incident hypertension, high BP and BP variability) among Nepali adults at Wave 1 (2013-2015) and Wave 2 scheduled for 2021-2022.


1. Geldsetzer P, Manne-Goehler J, Marcus ME, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults. Lancet. Aug 24 2019;394(10199):652-662. doi:10.1016/S0140-6736(19)30955-9

2. Aryal KK, Mehata S, Neupane S, et al. The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey. PLoS One. 2015;10(8):e0134834. doi:10.1371/journal.pone.0134834

3. Jafar TH, Gandhi M, de Silva HA, et al. A Community-Based Intervention for Managing Hypertension in Rural South Asia. N Engl J Med. Feb 20 2020;382(8):717-726. doi:10.1056/NEJMoa1911965

4. Loyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. Feb 2 2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703

5. Karmacharya BM, Koju RP, LoGerfo JP, et al. Awareness, treatment and control of hypertension in Nepal: findings from the Dhulikhel Heart Study. Heart Asia. 2017;9(1):1-8. doi:10.1136/heartasia-2016-010766

6. Shrestha S, Shrestha A, Koju RP, et al. Barriers and facilitators to treatment among patients with newly diagnosed hypertension in Nepal. Heart Asia. 2018;10(2):e011047. doi:10.1136/heartasia-2018-011047

Research Significance

While levels of cardiovascular disease risk factors and hypertension have been documented, few studies have investigated longitudinal changes, and none have previously monitored blood pressure (BP) variability in Nepal. The goal of this proposed study is to provide much-needed information on longitudinal risk factors and outcomes related to high BP and BP variability that will potentially promote strategies like community health worker-led BP monitoring for BP control in Nepal and resource-limited settings.


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