Document Type : Original Article(s)


1 Professor, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 PhD Candidate, Yazd Cardiovascular Research Centre, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 PhD Candidate, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND: The prevalence of hypertension (HTN) varies across countries due to differences in its related risk factors. This study aimed to investigate the prevalence of HTN and related risk factors among adults.METHODS: This study was conducted on the data from the recruitment phase of Yazd Health Study. Using multi-stage random cluster sampling, 10000 adults of 20-69 years were selected. Self-reported HTN (diagnosed by a physician) was recorded in a home visit. Blood pressure (BP) was measured using a standard protocol and categorized based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and ‎Treatment of High Blood Pressure ‎(JNC-7) classification. T-test was used to examine the gender differences. Qualitative variables were presented as number (frequency). Chi-square test and bivariate logistic regression were carried out to determine the association between risk factors.RESULTS: The response rate was 95% (n = 9975). The prevalence of positive history of HTN was 18.5%. The mean systolic and diastolic BP was 126.5 ± 18.4 and 80.2 ± 12.5 mmHg, respectively. The prevalence of HTN was 36.0% (95%CI: 35.1–36.9). Its prevalence reduced by high-education, physical activity, lower BMI, and lack of history of diabetes mellitus ‎(DM) (P < 0.0001). HTN is less common in smokers (P < 0.0001). Logistic regression analysis showed that HTN was higher among men (OR: 1.83; 95%CI: 1.64-2.03), the elderly (OR: 5.15; 95%CI: 4.20-6.31), low-educated (OR: 1.40; 95%CI: 1.17-1.67), and diabetics (OR: 1.20; 95%CI: 1.05-1.38). The prevalence of HTN was 2 times higher in obeses. HTN did not have a significant relationship with inactivity, smoking, and hypercholesterolemia.CONCLUSION: The prevalence of HTN was high. By identifying modifiable risk factors, health policymakers can prioritize intervention programs. It is necessary to inform younger adult groups how these factors can be managed through a healthy lifestyle and nutritional habits.


  1. World Health Organization. A global brief on hypertension: Silent killer, global public health crisis. Geneva, Switzerland: WHO; 2013.
  2. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1659-724.
  3. Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2016; 387(10017): 435-43.
  4. Tran J, Mirzaei M. The population attributable fraction of stroke associated with high blood pressure in the Middle East and North Africa.
  5. J Neurol Sci 2011; 308(1-2): 135-8.
  6. Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: A cross-sectional study. BMJ Open 2013; 3(8): e003423.
  7. Namayandeh SM, Sadr SM, Rafiei M, Modares-Mosadegh M, Rajaefard M. Hypertension in Iranian urban population, epidemiology, awareness, treatment and control. Iran J Public Health 2011; 40(3): 63-70.
  8. Vartiainen E, Laatikainen T, Peltonen M, Juolevi A, Mannisto S, Sundvall J, et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int J Epidemiol 2010; 39(2): 504-18.
  9. Mirzaei M, Salehi-Abargouei A, Mirzaei M, Mohsenpour MA. Cohort Profile: The Yazd Health Study (YaHS): A population-based study of adults aged 20-70 years (study design and baseline population data). Int J Epidemiol 2018; 47(3): 697-698h.
  10. Ogedegbe G, Pickering T. Principles and techniques of blood pressure measurement. Cardiol Clin 2010; 28(4): 571-86.
  11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289(19): 2560-72.
  12. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363(9403): 157-63.
  13. Moghaddam MH, Bakhtari Aghdam F, Asghari Jafarabadi M, Allahverdipour H, Dabagh Nikookheslat S, Safarpour S. The Iranian version of international physical activity questionnaire (IPAQ) in Iran: Content and construct validity, factor structure, internal consistency and stability. World Appl Sci J 2012; 18(8): 1073-80.
  14. Barzin M, Valizadeh M, Serahati S, Mahdavi M, Azizi F, Hosseinpanah F. Overweight and Obesity: Findings from 20 Years of the Tehran Lipid and Glucose Study. Int J Endocrinol Metab 2018; 16(4 Suppl): e84778.
  15. Yazd Province Census Results; December 2016. [online]. Available from:
  16. [In Persian].
  17. Eghbali M, Khosravi A, Feizi A, Mansouri A, Mahaki B, Sarrafzadegan N. Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: A cross-sectional study in Iran. Epidemiol Health 2018; 40: e2018020.
  18. Gurven M, Blackwell AD, Rodriguez DE, Stieglitz J, Kaplan H. Does blood pressure inevitably rise with age?: Longitudinal evidence among forager-horticulturalists. Hypertension 2012; 60(1): 25-33.
  19. Kazemi T, Hajihosseini M, Mashreghimoghadam H, Azdaki N, Ziaee M. Prevalence and determinants of hypertension among Iranian Adults, Birjand, Iran. Int J Prev Med 2017; 8: 36.
  20. Choi HM, Kim HC, Kang DR. Sex differences in hypertension prevalence and control: Analysis of the 2010-2014 Korea National Health and Nutrition Examination Survey. PLoS One 2017; 12(5): e0178334.
  21. Baksi AJ, Treibel TA, Davies JE, Hadjiloizou N, Foale RA, Parker KH, et al. A meta-analysis of the mechanism of blood pressure change with aging.
  22. J Am Coll Cardiol 2009; 54(22): 2087-92.
  23. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310(9): 959-68.
  24. Gharipour M, Khosravi A, Sadeghi M, Roohafza H, Hashemi M, Sarrafzadegan N. Socioeconomic characteristics and controlled hypertension: Evidence from Isfahan Healthy Heart Program. ARYA Atheroscler 2013; 9(1): 77-81.
  25. Di Giosia P., Giorgini P, Stamerra CA, Petrarca M, Ferri C, Sahebkar A. Gender differences in epidemiology, pathophysiology, and treatment of hypertension. Curr Atheroscler Rep 2018; 20(3): 13.
  26. Tabrizi JS, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz L, Nikniaz Z. Prevalence and associated factors of prehypertension and hypertension in Iranian population: The lifestyle promotion project (LPP). PLoS One 2016; 11(10): e0165264.
  27. Rani R, Mengi V, Gupta RK, Sharma HK. Hypertension and its risk factors-a cross sectional study in an urban population of a north Indian district. Public Health Res 2015; 5(3): 67-72.
  28. Singh S, Shankar R, Singh GP. Prevalence and associated risk factors of hypertension: A cross-sectional study in Urban Varanasi. Int J Hypertens 2017; 2017: 5491838.
  29. Mirzaei M, Moayedallaie S, Jabbari L, Mohammadi M. Prevalence of hypertension in Iran 1980-2012: A systematic review. J Tehran Heart Cent 2016; 11(4): 159-67.
  30. Katibeh M, Moghaddam A, Yaseri M, Neupane D, Kallestrup P, Ahmadieh H. Hypertension and associated factors in the Islamic Republic of Iran: A population-based study. East Mediterr Health J 2020; 26(3): 304-14.
  31. Wang J, Sun W, Wells GA, Li Z, Li T, Wu J, et al. Differences in prevalence of hypertension and associated risk factors in urban and rural residents of the northeastern region of the People's Republic of China: A cross-sectional study. PLoS One 2018; 13(4): e0195340.
  32. Li J, Shi L, Li S, Xu L, Qin W, Wang H. Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011. Int J Equity Health 2017; 16(1): 50.
  33. Sojasi Gheidari H, Sadeghloo T, Shahdadi A. The effects of globalization on lifestyle changes in rural areas. Interdisciplinary Studies in the Humanities 2015; 7(4): 153-88. [In Persian].
  34. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: A systematic literature review. Diabetes Metab Syndr Obes 2013; 6: 327-38.
  35. Najafian J, Nouri F, Mohammadifard N. Association between sleep duration and hypertension: Isfahan Healthy Heart Program, Iran. ARYA Atheroscler 2019; 15(1): 22-6.
  36. Khajedaluee M, Hassannia T, Rezaee A, Ziadi M, Dadgarmoghaddam M. The prevalence of hypertension and its relationship with demographic factors, biochemical, and anthropometric indicators: A population-based study. ARYA Atheroscler 2016; 12(6): 259-65.
  37. Zhang YX, Wang SR, Zhao JS, Chu ZH. Prevalence of overweight and central obesity and their relationship with blood pressure among college students in Shandong, China. Blood Press Monit 2016; 21(4): 251-4.
  38. Re RN. Obesity-related hypertension. Ochsner J 2009; 9(3): 133-6.
  39. Yang G, Ma Y, Wang S, Su Y, Rao W, Fu Y, et al. Prevalence and correlates of prehypertension and hypertension among adults in northeastern China: A Cross-Sectional Study. Int J Environ Res Public Health 2015; 13(1): 82.
  40. Pankova A, Kralikova E, Fraser K, Lajka J, Svacina S, Matoulek M. No difference in hypertension prevalence in smokers, former smokers and non-smokers after adjusting for body mass index and age: A cross-sectional study from the Czech Republic, 2010. Tob Induc Dis 2015; 13(1): 24.
  41. Halperin RO, Gaziano JM, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens 2008; 21(2): 148-52.
  42. Li G, Wang H, Wang K, Wang W, Dong F, Qian Y, et al. The association between smoking and blood pressure in men: A cross-sectional study. BMC Public Health 2017; 17(1): 797.
  43. Hegde SM, Solomon SD. Influence of physical activity on hypertension and cardiac structure and function. Curr Hypertens Rep 2015; 17(10): 77.
  44. Reichert FF, Azevedo MR, Breier A, Gerage AM. Physical activity and prevalence of hypertension in a population-based sample of Brazilian adults and elderly. Prev Med 2009; 49(2-3): 200-4.
  45. You Y, Teng W, Wang J, Ma G, Ma A, Wang J, et al. Hypertension and physical activity in middle-aged and older adults in China. Scientific Reports 2018; 8: 16098.