Prevalence and Risk Factors of Hypertension Among Young Adults in Albania



Hypertension is one of the major risk factors for cardiovascular disease and the leading cause of death worldwide. Hypertension was defined as systolic or diastolic blood pressure according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (ACC/AHA) rules.


The aims of this study was to determine the difference in hypertension prevalence and its risk factors using ACC/AHA rule, and compared its result with JNC7 rule.


Data were collected using two-stage stratified cluster sample of households from 2017/18 Albanian Demographic and Health Survey. Data were analyzed using the descriptive and multivariate logistic regression model.


Among 15,003 respondents aged 15–49 years, the overall prevalence of hypertension was 63.48% and 16.24%, as per ACC/AHA and JNC7 rules, respectively with an absolute increase of prevalence by 47.3% (CI 46.4–48.2%). According to the ACC/AHA rule, in most of the categories of the respondents, the prevalence of hypertension was 40% higher compared with the JNC7 rule. In multivariate analysis, age, education, richest respondents, number of living children (≥ 3), health insurance and gender had significant (p < 0.05) impact on hypertension for both rules. Besides, the middle and richer wealth index, religion, and physically active work had also significant (p < 0.05) impact on hypertension for JNC7 rules.


Newly established ACC/AHA rule led to a significant increase in the proportion of hypertension among the Albanian populations. Similarly, there was a significant difference in the impact of some socioeconomic factors on hypertension as per both rules. Implementation of the prevention and control programs of hypertension are required to increase the awareness of the bad impact of hypertension.

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  1. 1.

    Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, Casey DC, Charlson FJ, Coates MM, Coggeshall M, Cornaby L. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1603–58.

    Google Scholar 

  2. 2.

    Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Kayima J, Nankabirwa J, Sinabulya I, Nakibuuka J, Zhu X, Rahman M, Longenecker CT, Katamba A, Mayanja-Kizza H, Kamya MR. Determinants of hypertension in a young adult Ugandan population in epidemiological transition—the MEPI-CVD survey. BMC Public Health. 2015;15(1):830.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. 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):2560–71.

    CAS  PubMed  Google Scholar 

  5. 5.

    Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, Ahmed M, Aksut B, Alam T, Alam K, Alla F. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1–25.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Thawornchaisit P, de Looze F, Reid CM, Seubsman A, Sleigh AC. Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students. BMJ Open. 2013;3(6):e002826.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Whitworth JA. International Society of Hypertension Writing Group: 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.

    PubMed  Google Scholar 

  8. 8.

    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.

    PubMed  Google Scholar 

  9. 9.

    Khanam R, Ahmed S, Rahman S, Al Kibria GM, Syed JR, Khan AM, Moin SM, Ram M, Gibson DG, Pariyo G, Baqui AH. Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study. BMJ Open. 2019;9:e026722.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    O’Brien E. The Lancet Commission on hypertension: addressing the global burden of raised blood pressure on current and future generations. J Clin Hypertens. 2017;19(6):564–8.

    Google Scholar 

  11. 11.

    Ali J, Gul AM, Irfan M, Querishi MS, Faheem M, Hussain C, Khan SB, Shah SF, Hafizullah M. How frequent are cardiovascular risk factors in lawyers? Pak Heart J. 2012;45(2):91–6.

    Google Scholar 

  12. 12.

    Ghose B, Yaya S. Blood pressure-controlling behavior in relation to educational level and economic status among hypertensive women in Ghana. Fam Med Community Health. 2018;6(3):114–23.

    Google Scholar 

  13. 13.

    Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, Kazmi K. 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.

    CAS  PubMed  Google Scholar 

  14. 14.

    Pirkle CM, Ylli A, Burazeri G, Sentell TL. Social and community factors associated with hypertension awareness and control among older adults in Tirana, Albania. Eur J Public Health. 2018;28(6):1163–8.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Petrela E, Burazeri G, Pupuleku F, Zaimi E, Rahman M. Prevalence and correlates of hypertension in a transitional southeastern European population: results from the Albanian Demographic and Health Survey. Arch Ind Hyg Toxicol. 2013;64(4):479–87.

    Google Scholar 

  16. 16.

    Mackenbach J, and McKee M. Successes and failures of health policy in Europe: Four decades of divergent trends and converging challenges: Four decades of divergent trends and converging challenges. McGraw-Hill Education (UK), 2013.

  17. 17.

    Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ. 2017ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):127–248.

    Google Scholar 

  18. 18.

    Rahman M, Zaman MM, Islam JY, Chowdhury J, Ahsan HN, Rahman R, Hassan M, Hossain Z, Alam B, Yasmin R. Prevalence, treatment patterns, and risk factors of hypertension and pre-hypertension among Bangladeshi adults. J Hum Hypertens. 2018;32(5):334–48.

    PubMed  Google Scholar 

  19. 19.

    Tocci G, Presta V, Figliuzzi I, Miceli F, Citoni B, Coluccia R, Paini A, Salvetti M, Ferrucci A, Muiesan ML, Volpe M. Reclassification of hypertensive outpatients according to new US guidelines on high blood pressure. Am J Hypertens. 2019;32(1):77–87.

    CAS  PubMed  Google Scholar 

  20. 20.

    Shapo L, Pomerleau J, McKee M. Epidemiology of hypertension and associated cardiovascular risk factors in a country in transition: a population-based survey in Tirana City, Albania. J Epidemiol Community Health. 2003;57(9):734–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Gelber RP, Gaziano JM, Manson JE, Buring JE, Sesso HD. A prospective study of body mass index and the risk of developing hypertension in men. Am J Hypertens. 2007;20(4):370–7.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Burazeri G, Goda A, Sulo G, Stefa J, Roshi E, Kark JD. Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania. Croatian Med J. 2007;48(2):225–33.

    Google Scholar 

  23. 23.

    Shurdha O, Hasimi E, Petrela E, Goda A. Prevalence of major cardiovascular risk factors among adults in Albania. Int J Sci Res. 2015;4(12):604–7.

    Google Scholar 

  24. 24.

    Abariga SA, Khachan H, Al Kibria GM. Prevalence and determinants of hypertension in India based on the 2017 ACC/AHA guideline: evidence from the India national family health survey. Am J Hypertens. 2020;33(3):252–60.

    PubMed  Google Scholar 

  25. 25.

    Al Kibria GM, Swasey K, Angela KC, Mirbolouk M, Sakib MN, Sharmeen A, Chadni MJ, Stafford KA. Estimated change in prevalence of hypertension in Nepal following application of the 2017 ACC/AHA guideline. JAMA Netw Open. 2018;1(3):e180606.

    Google Scholar 

  26. 26.

    Al Kibria GM, Swasey K, Choudhury A, Burrowes V, Stafford KA, Uddin SI, Mirbolouk M, Sharmeen A, Angela KC, Mitra DK. The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh. J Hum Hypertens. 2018;32(8):608–16.

    Google Scholar 

  27. 27.

    Verdecchia P, Angeli F. The seventh report of the joint national committee on the prevention, detection, evaluation and treatment of high blood pressure: the weapons are ready. Rev Esp Cardiol. 2003;56(9):843–7.

    PubMed  Google Scholar 

  28. 28.

    Al Kibria GM, Swasey K, Hasan MZ, Choudhury A, Gupta RD, Abariga SA, Sharmeen A, Burrowes V. Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines. J Am Soc Hypertens. 2018;12(11):e45–55.

    PubMed Central  Google Scholar 

  29. 29.

    Kario K. Global impact of 2017 American Heart Association/American College of Cardiology hypertension guidelines: a perspective from Japan. Circulation. 2018;137:543–5.

    PubMed  Google Scholar 

  30. 30.

    Schiffrin EL. Global impact of the 2017 American College of Cardiology/American Heart Association hypertension guidelines: a perspective from Canada. Circulation. 2018;137:883–5.

    PubMed  Google Scholar 

  31. 31.

    Pinto E. Blood pressure and ageing. Postgrad Med J. 2007;83(976):109–14.

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Chowdhury MAB, Uddin, MJ, Haque MR, Ibrahimou, B. Hypertension among adults in Bangladesh: evidence from a national cross-sectional survey. BMC Cardiovasc Disord. 2016;16(1):22.

  33. 33.

    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903–13.

  34. 34.

    Sun Z. Aging, arterial stiffness, and hypertension. Hypertension. 2014;65(2):252–6.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    AlGhatrif M, Strait JB, Morrell CH, Canepa M, Wright J, Elango P, Scuteri A, Najjar SS, Ferrucci L, Lakatta EG. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the Baltimore Longitudinal Study of Aging. Hypertension. 2013;62(5):934–41.

    CAS  PubMed  Google Scholar 

  36. 36.

    Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49(1):69–75.

    CAS  PubMed  Google Scholar 

  37. 37.

    Hasan M, Sutradhar I, Akter T, Gupta RD, Joshi H, Haider MR, Sarker M. Prevalence and determinants of hypertension among adult population in Nepal: data from Nepal Demographic and Health Survey 2016. PLoS One. 2018;13(5):e0198028.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension. 2013;62(1):18–26.

    CAS  PubMed  Google Scholar 

  39. 39.

    Keetile M, Navaneetham K, Letamo G. Patterns and determinants of hypertension in Botswana. J Public Health. 2014;23(5):311–8.

    Google Scholar 

  40. 40.

    Laxmaiah A, Meshram II, Arlappa N, Balakrishna N, Rao KM, Reddy CG, Ravindranath M, Kumar S, Kumar H, Brahmam GN. Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in India. Indian J Med Res. 2014;141(5):697.

    Google Scholar 

  41. 41.

    Singh S, Shankar R, Singh GP. Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi. Int J Hypertens. 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Cuschieri S, Vassallo J, Calleja N, Pace N, Mamo J. The effects of socioeconomic determinants on hypertension in a cardiometabolic at-risk European country. Int J Hypertens. 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Peltzer K, Pengpid S. The prevalence and social determinants of hypertension among adults in Indonesia: a cross-sectional population-based national survey. Int J Hypertens. 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, Pourshams A, Poustchi H, Navabakhsh B, Naemi M, Pharoah PD. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens. 2013;31(7):1364.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Scholes S, Bajekal M, Love H, Hawkins N, Raine R, O’Flaherty M, Capewell S. Persistent socioeconomic inequalities in cardiovascular risk factors in England over 1994-2008: a time-trend analysis of repeated cross-sectional data. BMC Public Health. 2012;12(1):129.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Reddy KS, Naik N, Prabhakaran D. Hypertension in the developing world: a consequence of progress. Curr Cardiol Rep. 2006;8(6):399–404.

    PubMed  Google Scholar 

  47. 47.

    Seedat YK. Impact of poverty on hypertension and cardiovascular disease in sub-Saharan Africa. Cardiovasc J Afr. 2007;18(5):316.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Lear SA, Teo K, Gasevic D, Zhang X, Poirier PP, Rangarajan S, Seron P, Kelishadi R, Tamil AM, Kruger A, Iqbal R. The association between ownership of common household devices and obesity and diabetes in high, middle- and low-income countries. CMAJ. 2014;186(4):258–66.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Magallanes, JM. Human nutrition: the impact of family size and income on dietary intake. Philippine Sociol Rev. 1984;69–79.

  50. 50.

    Mekonnen TT, Woldeyohannes SM, Yigzaw T. Contraceptive use in women with hypertension and diabetes: cross-sectional study in northwest Ethiopia. Int J Women’s Health. 2015;7:957–64.

    Google Scholar 

  51. 51.

    Oso AA, Adefurin A, Benneman MM, Oso OO, Taiwo MA, Adebiyi OO, Oluwole O. Health insurance status affects hypertension control in a hospital based internal medicine clinic. Int J Cardiol Hypertens. 2019;1:100003.

    PubMed  PubMed Central  Google Scholar 

  52. 52.

    Fang J, Zhao G, Wang G, Ayala C, Loustalot F. Insurance status among adults with hypertension—the impact of underinsurance. J Am Heart Assoc. 2016;5(12):e004313.

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Keith C, Norris KC. Health insurance and blood pressure control. J Am Heart Assoc. 2016;5:e005130.

    Google Scholar 

  54. 54.

    Sampson UK, Edwards TL, Jahangir E, Munro H, Wariboko M, Wassef MG, Fazio S, Mensah GA, Kabagambe EK, Blot WJ, Lipworth L. Factors associated with the prevalence of hypertension in the southeastern United States: insights from 69 211 blacks and whites in the southern community cohort study. Circ Cardiovasc Qual Outcomes. 2014;7(1):33–54.

  55. 55.

    Ghosh S, Mukhopadhyay S, Barik A. Sex differences in the risk profile of hypertension: a cross-sectional study. BMJ Open. 2016;6(7):e010085.

    PubMed  PubMed Central  Google Scholar 

  56. 56.

    Tocci G, Presta V, Ferri C, Redon J, Volpe M. Blood Pressure Targets Achievement According to 2018 ESC/ESH guidelines in three european excellence centers for hypertension. High Blood Pressure Cardiovasc Prev. 2020;27(1):51–9.

    Google Scholar 

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Authors acknowledge the Demographic and Health Surveys (DHS) Program for providing data. The authors are grateful to the Statistics Discipline, Khulna University, Khulna-9208, Bangladesh, where this study is conducted. Authors are also thankful to authors of different articles are used in this study.

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Correspondence to Benojir Ahammed.

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Benojir Ahammed designed the design of this study, after collecting and checking the data, performed the statistical analysis and write the manuscript; Md. Maniruzzaman checked the data and edited the manuscript; Ashis Talukder edited the manuscript; Farzana Ferdausi review relavent literature and write the manuscript. All authors have read and approved the final manuscript.

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Ahammed, B., Maniruzzaman, M., Talukder, A. et al. Prevalence and Risk Factors of Hypertension Among Young Adults in Albania. High Blood Press Cardiovasc Prev 28, 35–48 (2021).

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  • Hypertension
  • Prevalence
  • Risk factors
  • Albania