Urbanisation of developing countries has had a marked impact on population health. In particular, in India, the prevalence of coronary heart disease is markedly increased in urban versus rural settings. The aim of the current study was to assess the impact of geographic location on large artery stiffness and central blood pressure (BP) as part of the PURSE-HIS study.

Methods: In all, 7676 individuals (4276 females) from three distinct geographical regions of Tamil Nadu, India were studied. The mean age was 44±10 years (range 19–79 years). Following completion of a detailed medical history questionnaire, all participants underwent haemodynamic screening including brachial and central BP, augmentation index (AIx) and aortic pulse wave velocity (PWV, SphygmoCor). Subjects were then grouped according to geographical region (urban, semi-urban and rural) and decade of age.

Clinic brachial and central BP increased significantly with age in all three geographical regions (P<0.001). However, both brachial and central pressures were significantly lower in rural participants at all ages (P<0.001 for all). Aortic PWV also significantly increased with age in all geographical regions (P<0.001 for all). However, the age-associated increase in PWV was significantly attenuated in rural participants (P<0.001), even after adjusting for confounders (Figure 1). In contrast, AIx was significantly higher in younger rural individuals (<40 years,P<0.001), although this difference was not evident in older individuals.

These data indicate that urban lifestyle adversely impacts on blood pressure and large artery stiffness in an Indian population, which may contribute to the increased cardiovascular risk observed in these individuals.