Page 590 VOJNOSANITETSKI PREGLED Vojnosanit Pregl 2020; 77(6): 590–600

ORIGINAL ARTICLE UDC: 616-036.22:616.12-008.331.1-02

https://doi.org/10.2298/VSP180330114S

Prehypertension and hypertension prevalence and risk factors among

adult population in Republic of Serbia: A cross-sectional study
Prevalencija i faktori rizika od prehipertenzije i hipertenzije kod odrasle
populacije u Republici Srbiji: studija preseka

Sandra Šipetić Grujičić*, Dragan Miljuš†, Ivan Soldatović‡,

Aleksandra Nikolić*, Isidora Vujčić*

University of Belgrade, Faculty of Medicine, *Institute of Epidemiology, ‡Department of

Medical Statistics and Informatics, Belgrade, Serbia; †Institute of Public Health of
Serbia “Dr Milan Jovanović Batut”, Belgrade, Serbia

Abstract risk factors for hypertension compared to persons with

normotension were older age (50 and more) (p < 0.001),
Background/Aim. Prehypertension and hypertension are overweight (p < 0.001) and obesity (p < 0.001), moderate
an important public health problem worldwide and al- (p < 0.001) and large (p < 0.001) waist circumference in
though they can be modified, they are often a risk for car- both sexes, and nonurban place of residence in females
diovascular diseases. The aim of this study was to determine (p = 0.006). In females, independently significant risk fac-
the prevalence of prehypertension and hypertension and as- tors for prehypertension compared to persons with nor-
sociated risk factors in the adult population (15+ years) of motension were older age (50 and more) (p < 0.001), over-
Serbia. Methods. The cross-sectional study covered 14,623 weight (p < 0.001) and obesity (p < 0.001), moderate
adult respondents, but 14,422 volunteered to measure their (p < 0.001) and large (p < 0.001) waist circumference, but
blood pressure according to a pre-defined protocol. A strati- high level of physical activity was significantly protective
fied two-stage national representative random sampling ap- (p = 0.014). In males, overweight (p < 0.001) and obesity
proach was used for the selection of the survey sample. Re- (p < 0.001) were independently significant risk factors for
sults. In 2013, 17.7% of Serbian population, aged 15 and prehypertension. Conclusion. Serbia belongs to countries
over, was normotensive, every third (33.1%) person had with a high prevalence of prehypertension and hyperten-
prehypertension, and every second (49.3%) had hyperten- sion. Our results emphasize the need for a new public
sion. The standardized prevalence of prehypertension and health strategy for the prevention, detection and treatment
hypertension was 40.6% and 34.5%, respectively; 57.8% of of prehypertension and hypertension.
the hypertensive population were receiving medical treat-
ment. Among those receiving medical treatment, 35.2% Key words:
(36.4% males and 33.2% females) had a blood pressure adults; age factors; cardiovascular diseases; hypertension;
within the normal range. According to the results of multi- obesity; overweight; prehypertension; risk factors;
variate logistic regression analysis, independently significant prevalence; sex factors.

Apstrakt uzorak stanovništva Srbije. Rezultati. U 2013, 17,7% odra-

slih osoba, uzrasta 15+ godina bilo je normotenzivno, svaka
Uvod/Cilj. Prehipertenzija i hipertenzija su važni javnoz- treća (33,1%) osoba imala je prehipertenziju, a svaka druga
dravstveni problemi širom sveta. Mada se na njih može uti- (49,3%) hipertenziju. Standardizovana prevalencija prehiper-
cati, oni su skoro uvek faktori rizika od kardiovaskularnih tenzije bila je 40,6%, hipertenzije 34,5%, a 57,8% hiperten-
bolesti. Cilj istraživanja bio je da se utvrde prevalencija i fak- zivnih osoba bilo je na antihipertenzivnoj terapiji. Među
tori rizika prehipertenzije i hipertenzije kod odrasle popu- osobama koje su bile na medikamentnoj terapiji 35,2%
lacije (15+ godina) u Srbiji. Metode. Studijom preseka (36,4% muškaraca i 33,2% žena) imalo je krvni pritisak unu-
obuhvaćeno je 14 623 odraslih ispitanika, od kojih je 14 422 tar normalnih vrednosti. Prema rezultatima multivarijantne
pristalo na merenje krvnog pritiska u kućnim uslovima. logističke regresione analize, značajni nezavisni faktori rizika
Korišćen je stratifikovani dvoetapni reprezentativni slučajni od hipertenzije, u odnosu na osobe sa normotenzijom, bili

Correspondence to: Sandra Šipetić Grujičić, University of Belgrade, Faculty of Medicine, Institute of Epidemiology, Višegradska 26,
11 000 Belgrade, Serbia. E-mail: sandra.grujicic2014@gmail.com
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su životno doba (50+ godina) (p < 0,001), prekomerna jaznost (p < 0,001) bili su značajni nezavisni faktori rizika
težina (p < 0,001) i gojaznost (p < 0,001), umerenо veliki (p od prehipertenzije. Zaključak. Srbija pripada zemljama sa
< 0,001) i velik (p < 0,001) obim struka kod osoba oba pola, visokom prevalencijom prehipertenzije i hipertenzije. Naši
a kod žena i mesto boravka van grada (p = 0,006). Kod rezultati naglašavaju potrebu za novom javnozdravstvenom
žena, značajni nezavisni faktori rizika od prehipertenzije, u strategijom za prevenciju, otkrivanje i lečenje osoba sa pre-
poređenju sa osobama sa normotenzijom, bili su starije hipertenzijom i hipertenzijom.
životno doba (50 + godina) (p < 0,001), prekomerna težina
(p < 0,001) i gojaznost (p < 0,001), umereno veliki Ključne reči:
(p < 0,001) i veliki (p < 0,001) obim struka, dok je visok ste- odrasle osobe; životno doba, faktor; kardiovaskularne
pen fizičke aktivnosti bio značajan protektivni faktor (p = bolesti; hipertenzija; gojaznost; telesna masa, prekomer-
0,014). Kod muškaraca, prekomerna težina (p < 0,001) i go- na; prehipertenzija; faktori rizika; prevalenca; pol, faktor.

Introduction gion (under the UN Mission), persons who were mentally

unable to participate in the survey and examinees for whom
Prehypertension (PreHTN) and hypertension (HTN) are there were no data for the requested variables.
an important public health problem worldwide and although
they can be modified, they are often a risk for cardiovascular Sampling design
diseases (CVD), cerebrovascular diseases (stroke) and kid-
ney diseases in the terminal phase 1, 2. It is estimated that ap- This cross-sectional study was performed in line with
proximately 40% of adult population of the world have diag- recommendations of EUROSTAT, The European Health In-
nosed HTN, which makes an average of 9.4 million people terview Survey wave 2, and Methodological Manual 7, 8. For
who die annually 1. HTN is responsible for approximately obtaining the sample of households and examinees, a strati-
half of the deaths from CVD and stroke. PreHTN elevates fied two-stage national representative random sampling ap-
the risks of CVD (RR = 1.55), coronary heart disease (RR = proach was used. In Serbia, 4 administrative areas were
1.50) and stroke (RR = 1.71) 3. identified: Vojvodina, Belgrade, Šumadija and Western Ser-
In the adult population aged 25 and over, the age- bia and Eastern and South Serbia. A further stratum
standardized prevalence of HTN is the highest in underde- classification was urban vs. other area of residence. In the
veloped countries and developing countries (Africa – 46%), first stage of 2-stage sampling, census circles were selected
while the lowest is in developed countries of the world (total, 670 census circles: Belgrade – 162, Vojvodina – 187,
(North America – 35%). The majority of people with undi- Šumadija and Western Serbia – 179 and Eastern and South
agnosed, untreated and uncontrolled HTN lives in low- and Serbia – 142) by probability proportional sampling. In the
middle-income countries with insufficiently developed second stage, households were selected by a linear method of
health systems 1. sampling, with a random beginning and an equal selection
PreHTN prevalence and HTN prevalence are attributed interval, by random sampling without replacement. In the
to the growth and aging of the population and risk behaviors second stage, households were selected by a linear method of
such as malnutrition, overweight, harmful use of alcohol, sampling, with a random beginning and an equal selection
smoking tobacco, insufficient physical activity, high choles- interval, by random sampling without replacement. The 2011
terol, diabetes and long-term stress exposure 4–6. Serbian population census framework was used for the selec-
However, little is known about the epidemiology of tion of clusters. From every census circle 10 households
PreHTN and HTN in the adult population of Serbia. The aim were selected (total, 6,700 households). Out of 6,700 house-
of the study was to determine the prevalence of PreHTN and holds planned, a sample of 6,500 households was accepted to
HTN and associated risk factors in the adult population (15+ be include in this study (the household response rate –
years) of Serbia. 97.0%). Out of 16,474 registered members of households
aged 15 and over, 14,623 agreed to be interviewed (response
Methods rate of 88.8%). Out of the adult household members, 14,422
adult respondents whom blood pressure (BP) were measured
Data for this cross-sectional study were obtained from at home were included in our study (response rate of 98.6%).
the National Survey of the Population of Serbia in 2013 that The research was approved by the Ethics Committee of
was carried out by the Ministry of Health of Serbia and the The Faculty of Medicine, University of Belgrade (29/IV-16)
Institute of Public Health of Serbia “Dr Milan Jovanović Ba- and the Ethics Committee of the Institute for Public Health
tut”. The research was carried in the period October 7th, of Serbia “Dr Milan Jovanović Batut” (1567/1).
2013 to December 30th, 2013. The study population included
adults ≥ 15 years old, permanent residents of the Republic of Instruments and variables
Serbia. Exclusion criteria were: age below 15 years, persons
who lived in collective households and/or institutions (insti- The research of health of the population in Serbia was
tutions of social protection, nursing homes, prisons, and psy- conducted by collecting data with three questionnaires
chiatric institutions), residents of Kosovo and Metohija re- (household questionnaire, personal health questionnaire and

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self-completing questionnaire) for population above 15 Statistical analysis

years. The questionnaires were written according to the rec-
ommendations of Eurostat Working Group on Public Health Prevalence rates with appropriate 95% confidence in-
Statistics of the European Commission 7. Variables included tervals (CI) were estimated for 3 categories of BP according
in analysis from those questionnaires were: gender to age, place of residence, BMI, WC and physical activity,
(male/female), age (< 49, 50–59 and 60 and more years), but separately for males and females participants. The preva-
place of residence (town/the other; a town is a territorial unit lence of normotensive, PreHTN and HTN subjects were age
established by the law, which is an economic, administrative, and sex standardized according to the 2010 world population
geographic and cultural center and has more than 100,000 using the direct method 12.
inhabitants; other territorial units, according to the stated law In statistical analysis of data, Pearson χ2 test, univariate
and administrative-legal criteria, do not fulfill these condi- logistic regression analysis (ULRA) and multivariate logistic
tions) and duration of daily physical activity – walking regression analysis (MLRA) were used. χ2 test was used to
and/or riding a bicycle (low: 10–29 min/daily; moderate: 30– find statistically significant differences according to sex and
59 min/daily; high: 60 and more min/daily) 8. between BP categories according to categories of age, place
of residence, BMI, WC and physical activity, but separately
Measurements for males and females participants.
Association between categories of BP and health related
After the interview with the households, previously factors were analyzed with ULRA and MLRA. Variables
trained persons carried out objective measurements accord- that according to ULRA had p value ≤ 0.1 were included into
ing to defined standardized procedures. A digital BP monitor the model of MLRA. The dependent variables formed two
with suitable cuffs was used for measuring BP. BP was different multivariable models – PreHTN and HTN, each of
measured by automatic upper arm BP monitor, three times them vs. normal BP as referent category, separately for
with pauses of at least one min. For the categorization of the males and females. Independent variables were: age, place of
level of BP, the average value of all three measurements was residence, BMI, WC and physical activity. They were re-
used and information of treated HTN over the last 4 weeks. ported with odds ratios and their 95% CI, along with prob-
According to the classification of the World Health Organi- ability p. The computer program SPSS for Windows, version
zation (WHO) 9, the examinees without antihypertensive 20.0 (US Government of Commercial Computer Software,
therapy over the last 4 months were classified according to Chicago, USA, 2012) was used in statistical analysis of the
values of BP into the following categories: normal blood data. Statistical hypotheses were tested on the level of statis-
pressure (systolic BP – SBP and diastolic BP – DBP: < 120 tical significance from 0.05.
and < 80 mmHg); PreHTN (SBP/DBP: 120–139 and/or 80–
89 mmHg); and HTN (SBP/DBP: ≥ 140 and/or ≥ 90 mmHg). Results
All persons who used antihypertensive therapy over the last
4 weeks were included in the category of hypertensive indi- The cross-sectional study included 14,422 participants
viduals. Among the subjects with HTN, 45.9% (1,532) of (6,652 – 46.1% of men and 7,770 – 53.9% of women) (re-
men and 68.3% (2,571) of women was on antihypertensive sponse rate 98.6%). The largest percentage of our sample of
treatment. In population who knew that they had HTN, only the population consisted of people under the age of 50
85.3% of females and 75.2% of males used antihypertensive (49.1% of males and 46.0% of females), from urban place of
therapy over the last 4 weeks. residence (55.1% of males and 57.4% of females), with
Anthropometric measurements were carried out accord- overweight and obesity (62.8% of males and 54.0% of fe-
ing to standard international procedures. Body height was males) and with moderately and large WC (58.5% of males
measured with the portable height measuring rod, body mass and 70.5% of females) (Table 1). About 40% of men and
with the electronic scale for medical usage with decimal about 50% of women did not perform physical activity suffi-
scale, and the waist circumference (WC) with the nonelastic ciently (i.e. the physical activity they performed was shorter
strip for measuring, which is 205 cm long. Body mass index than 30 min per day). People with HTN, for both sexes, were
(BMI), as the measure of weight 10, which was obtained as more often an older, from nonurban place of residence, with
the ratio of body mass and the squared body height (m2), was overweight and obesity, with large WC and low physical ac-
classified according to the criteria of WHO: underweight – tivity in relation to normotensive and PreHTN individuals.
BMI < 18.5 kg/m2, normal weight – BMI 18.5–24.9 kg/m2, Among people with hypertension (7,104), only 57.8%
overweight (pre-obesity) – BMI 25.0–29.9 kg/m2, obesity – used antihypertensive therapy over the last 4 weeks. Among
BMI ≥ 30.0 kg/m2. those receiving medical treatment, only 35.2% (36.4% males
WC was measured at the midpoint between the lower and 33.2% females) had a BP within the normal range. Users
border of the rib cage and the iliac crest by using a flexible of medical treatment for HTN were more often females
inch tape. The following cut off values of WC were used to (62.7%), elderly people (60 and older – 68.9%), people from
assess the abdominal obesity for women: normal < 80 cm, urban areas (56.0%), with overweight and obesity (78.3%),
moderate 80–87 cm, large ≥ 88 cm; and for men: normal with moderate and large WC (85.9%) and with low physical
< 94 cm, moderate 94–101 cm, large ≥ 102 cm 11. activity (less than 30 min per day) (52.4%).

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In the Serbian population, aged 15 and over, in 2013, Discussion

17.7% of population was normotensive, every third (33.1%)
person had PreHTN, and every second (49.3%) person had In the adult population of Serbia, aged 15 and over, in
HTN (Table 2). Men had significantly higher prevalence of 2013, high prevalence of PreHTN (33.1%; standardized pre-
PreHTN, as well as HTN than women for all age groups and valence 40.6%) and HTN (49.3%; standardized prevalence
total, except for HTN for age group 60+ years where preva- 34.5%) were identifed. Both age-standardized prevalences
lence was higher in women. In both sexes and in total, the were higher in men (48.5% and 38.6%, respectively) than in
prevalence of HTN increased with age, while PreHTN preva- women (33.4% and 30.6%, respectively). Among the sub-
lence decreased. In Serbia, the standardized prevalence of jects with HTN, only 45.9% of men and 68.3% of women
PreHTN was 40.6% (men 48.5% and women 33.4%) and (57.8% of all) was on antihypertensive treatment. Among
34.5% for HTN (men 38.6% and women 30.6%). those receiving medical treatment, only 35.2% (36.4% of
In urban population, as well as in nonurban one, preva- males and 33.2% of females) had BP within the normal
lence of PreHTN and HTN was significantly higher in males range. In the United States in 2004 prevalence of antihyper-
than in females (Table 3). Among both sexes, prevalence of tensive medication use among HTN adults, 18 years and
PreHTN was higher in urban population (41.4% of males, more, was 77.3%, more often among women (82.5%) and
and 28.8% of females), while HTN prevalence was signifi- individulas 60 years and more (83.6 %) 13. Among adult
cantly higher in nonurban population (50.3% of males, and Chinese 35–75 years of age, 30.1% take medication for HTN
48.3% of females). in the period 2014–2017 14. In Serbia and in other developing
Males had significantly higher prevalence of PreHTN countries prevalence of PreHTN and HTN is high and rates
and HTN for all BMI categories, except for overweight and of awareness, treatment, and control are low 15. Therefore,
obesity, where prevalence of HTN was higher in females. epidemiological situation of HTN in our country is alarming;
Prevalence of normotension and PreHTN decreased, while there is a huge hidden burden of undiagnosed HTN subjects
HTN increased with the increase in BMI, for both sexes. The and that requires urgent attention. If we add those with
highest prevalence of HTN was in obese category for both PreHTN, the magnitude of the problem is much higher.
sexes (69.8% of males, and 75.3% of females). Worldwide age-standardized prevalence of HTN in
Males had significantly higher prevalence of PreHTN adults, 20 years and above, in 2010, was 31.1% (31.9% in
and HTN for all WC categories. Prevalence of normotension men and 30.1% in women), and it was lower in high-income
and PreHTN significantly decreased, while HTN increased countries (28.5% in both sexes, 31.6% in men and 25.3% in
with the increase in WC, for both sexes. The highest preva- women) than in low- and middle-income countries (31.5% in
lence of PreHTN was in normal WC category (51.0% of males, both sexes, 31.7% in men and 31.2% in women) 16. It was es-
and 35.4% of females), while HTN prevalence was highest in timated that 1.4 billion people had HTN on the global level.
large WC (67.0% of males, and 66.7% of females). Aproximately ¾ of individuals with HTN lived in low- and
The prevalence of PreHTN and HTN was significantly middle-income countries. In the same year, the highest pre-
higher in males for all physical activity categories. Preva- valence for men was in Europe and Central Asia (38.8%) and
lence of normotension increased while the prevalence of for women in sub-Saharan Africa (36.3%), but the lowest for
HTN decreased with the increase in physical activity levels, men was in South Asia and for women in high-income econ-
in both sexes. Prevalence of PreHTN was highest in high omies (26.9%). It is estimated that HTN prevalence has de-
physical activity category for males (43.1%) and in moderate creased in high-income countries and increased in low- and
physical activity category for females (30.6%). The highest middle-income countries between 2000 and 2010 16. In low-
prevalence of HTN was among males (52.0%) and females and middle-income countries, aging and urbanisation with
(50.3%) with low physical activity. unhealthy lifestyle may play a role in the epidemic of
Variables that according to ULRA had p value ≤ 0.1 HTN 16–18.
were included into the model of MLRA. For normotension In some investigations, prevalence of PreHTN was also
and HTN these variables were age, place of residence, BMI, analized. For example, in the National Health and Nutrition
WC, and physical activity, in both sexes. According to the Examination Survey the prevalence of PreHTN in disease-
results of MLRA, independently significant risk factors for free US adults, over the age of 20 years, was 36.3% and was
HTN compared to persons with normotension were older age higher in men (44.8%) than in women (27.3%) 19. Also, pre-
(50 and more), overweight and obesity, moderate and large valence increased with age (31.2% for ages 20–39 years,
WC in both sexes, and nonurban place of residence in fe- 42.3% for ages 40–59 years and 44.2% for ages 60–69
males (Table 4). years). But, in our study, in both sexes and in total, the
Variables for normotension and PreHTN included into prevalence of PreHTN decreased. There is growing evidence
the model of MLRA were BMI and WC for males, and age, that individuals with PreHTN would have a significantly
BMI, WC and physical activity in females. In females, inde- higher risk of developing HTN and CVDs within a few years 20.
pendently significant risk factors for PreHTN were older age In our research, as in most other studies, the prevalence
(50 and more), overweight and obesity, moderate and large of PreHTN and HTN was higher in males than in fe-
WC, but high level of physical activity was significantly pro- males 16, 21, 22. The differences in the frequency of high BP
tective. In males, overweight and obesity were independently between the sexes can be partly explained by biological fac-
significant risk factors for PreHTN (Table 4). tors that include sex hormones, chromosomal differences,

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and other biological gender differences that protect women intensity physical activity per week or equivalent) 33. Preva-
from HTN until women reach menopause and after that gen- lence of physical inactivity is higher in high-income coun-
der differences in HTN become smaller or nonexistent 23, 24. tries and amounts to 32.7% (27.7% of men and 37.6% of
In our study, according to MLRA results, independently women). Physical inactivity is higher in women than in men
significant risk factors for HTN compared to persons with and is more frequent in older age groups. Daily exercise of at
normotension were older age (50 and more), overweight and least 30 min of physical activity can reduce BP and prevent
obesity, moderate and large WC in both sexes, and nonurban the development of pre-HTN and HTN 33. The mechanisms
place of residence in females. In females, independently sig- by which physical activity may reduce BP and prevent the
nificant risk factors for PreHTN were the same as for men development of PreHTN and HTN are unclear. Same animal
with HTN and high level of physical activity was signifi- studies suggest that aerobic exercise may prevent increases
cantly protective factor. In males, only overweight and obe- in BP by increasing insulin sensitivity and autonomic nerv-
sity were independently significant risk factors for PreHTN. ous system function 34, while resistance training may prevent
These results are very important because in a small increases in BP through beneficial alterations in vasocon-
number of studies independent risk factor for HTN was ana- striction regulation 35.
lyzed according to sex. Age has been recognized as a risk Exploring the regional differences and an in-depth
factor for HTN and some researchers believe that high preva- analysis of the urban and rural variations in prevalence may
lence of HTN among older people might be due to changes provide important insight into the underlying determinants of
that occur in the blood vessels 25. the increasing PreHTN and HTN. In most studies, living in
The results of this study are similar with the findings of urban areas was positively associated with HTN 36. Urbani-
the studies of Hu et al. 21, Dua et al. 26, Tripathy et al. 27 and zation influences lifestyle patterns, leading to a decrease in
Erem et al. 28 who noticed that overweight and obesity lead physical activity, changes in food consumption, and in-
to PreHTN and HTN in both sexes. In addition, the preva- creased stress 36. However, a small number of recent studies
lence of HTN appears to increase even with a relatively showed that the HTN prevalence was higher in rural areas
small increase in body weight 29. Similarly, among post- than in urban ones. In Turkish adult population aged 20 years
menopausal women, the risk of developing high BP is dou- or more, the overall (age-standardized) prevalence of HTN
bled with a high BMI or high WC 30. Deng et al. 31 and Hu et was 24.9%, and was higher in rural (28.4%) than in urban ar-
al. 21, also found that BMI and WC were positively related to eas (23.9%) 37. Women were more likely to had HTN in rural
the prevalence of HTN. The prevalence of PreHTN and HTN areas than in urban areas (p < 0.05). In our study, similar to
increased with an increase in BMI. The prevalence of these results, nonurban place of residence in females was in-
PreHTN decreased in parallel to an increase in the preva- dependent risk factor for HTN. In our females, prevalence of
lence of HTN. This was particularly noted in subjects up to HTN was 50.3% in nonurban and 47.6% in urban place. Pos-
44 years of age. In relation to individual nutrition indicators, sible explanation for our results could be emerging urbaniza-
the WC and BMI combination proved to be superior in pre- tion in rural areas. This suggests that analyzing HTN risk
dicting risk factors for HTN 32. factors according to gender may provide greater insight in
In our study, men with PreHTN and HTN had higher understanding the variations in HTN development between
prevalence of overweight (39.8% and 52.8%, respectively) urban and rural areas.
and obesity (26.8 and 69.8%, respectively) than women Noncommunicable diseases represent an upcoming epi-
(28.1% and 57.1%, respectively for overweight, and 18.4% demic for developing countries, including Serbia. In the light
and 75.3%, respectively for obesity). The prevalence of of this trend, the current study casts a significant light on the
overweight and obesity in both sexes increased with an in- prevalence of HTN in our country.
crease in BP and was the highest in people with HTN. Im- Limitations of this study include: cross-sectional study
proved living standard has led to an increase in obesity design which implies that no causal conclusion about the re-
throughout the world, especially during childhood. In the lationship between health behavior and anthropometric pa-
United States, 70.9% of adult men and 61.9% of women are rameters variables and BP values can be made; the data
overweight, and nearly one-third of the adult population, based on self-reporting for physical activity could lead to re-
31.6% of men and 33.9% of women are obese 32. In Sub- call bias, which may have prevented us from accurately es-
Saharan Africa, the highest prevalence of obesity was re- timating the association between physical activity and BP
corded among women in South Africa (42.0%). categories. Some risk factors, which are important in risk as-
In our study, only in PreHTN women, high level of sessment, were not taken into accounts, such as psychosocial
physical activity (60 and more min per day) was an inde- factors, social class, smoking, nutrition habits and others.
pendently significant protective factor for PreHTN develop-
ment, but not for HTN. Adults who are insufficiently physi- Conclusion
cally active have 20%−30% increased risk of all-cause mor-
tality compared to those who do at least 150 min of moder- Serbia belongs to countries with a high prevalence of
ate-intensity physical activity per week, or equivalent (as prehypertension and hypertension and the prevalence of un-
recommended by the WHO) 33. In 2010, globally, 23.3% of diagnosed and untreated hypertension is high in the adult
adults (19.8% of men and 26.8% of women) were insuffi- population of Serbia. Our results emphasize the need for a
ciently physically active (less than 150 min of moderate- new public health strategy for the prevention, detection and

Šipetić Grujičić S, et al. Vojnosanit Pregl 2020; 77(6): 590–600.

Vol. 77, No 6 VOJNOSANITETSKI PREGLED Page 599

treatment of prehypertension and hypertension. Moreover, Acknowledgement

regular physical activity and weight reduction through edu-
cation and awareness among people are the key to reducing We are grateful for the assistance of the Ministry of
the load of prehypertension, hypertension and cardiovascular Health of the Republic of Serbia, which authorized the use of
diseases. The results of this research can help decision mak- the database for the project Investigation of Population
ers in the health system to establish interventions that will Health in Serbia, 2013. This work was supported by the Min-
more effectively control prehypertension and hypertension in istry of Education, Science and Technological Development
our country. of the Republic of Serbia, Contract No 175042 (2011–2018).

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Šipetić Grujičić S, et al. Vojnosanit Pregl 2020; 77(6): 590–600.

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