The correlation between high blood pressure (BP) and urban neighborhood-level environmental determinants is understudied in low-income and middle-income countries (LMICs). We hypothesized that neighborhoods constitute exposures that affect resident-behaviors, metabolism and increased susceptibility to high BP. We studied urban clusters of Mumbai-Parsis (Zoroastrians), a founder population group, to minimize genetic variation and maximize exposure assessment. Participants from four neighborhoods were 19-53 years old and comprised 756 females and 774 males. We recorded healthy BPs (≤120/80 mmHg) in 59%, pre-hypertensive (≥121-139/81-89 mmHg) in 21% and high BP (≥140/90 mmHg) in 21% of the participants. A family history of hypertension had no correlation with high BP. We used the Neighborhood Accessibility Framework to compile a questionnaire in order to collect data on participants' perception of space, third places, streetscape and experience, land use, connectivity, surveillance, pedestrian safety and public transport. Our results suggested that participants in neighborhoods with poorer BP outcomes reported lower accessibility scores for space, streetscape and experience, third places and connectivity. Our study evaluates how neighborhood-level determinants affect BP outcomes in order to contribute to the body of knowledge on primary preventive measures for high BP in urban LMIC populations. We concluded that neighborhood exposures affect resident-behaviors, which cause metabolic changes and increase susceptibility to high BP.
Keywords: India; LMICs; Mumbai; Parsi (Zoroastrian); blood pressure; environment; exposome; hypertension; megacities; neighborhoods; urbanization.