CHAPTER 10 INTRODUCTION Tibetans are believed to have lived at high altitudes for longer than other high-altitude populations of the world (Moore, 1998). Dalai Lama of Tibet was given asylum in India after the political up-heals in 1959. Following Dalai Lama some 80,000 Tibetans fled to India. Tibetan refugees have been living in different parts of India for more than four decades. The different parts of India offer them different climatic and cultural environment; compared with those in which they lived in Tibet. Nutritional status of a population is a very good indicator of overall health status of a population. In the present paper the Nutritional status of the refugee population has been studied with respect to the altitude of residence. Nutritional status has been found to be associated with many different morbidity conditions and in effect mortality as well (James et al., 1988; Ferro-Luzzi et al., 1992; Naidu and Rao, 1994; Park, 2003). Relationship of mortality and Body Mass Index (BMI) an indicator of Nutritional status is U- or J- shaped (Lee et al., 1993; Shetty and James, 1994; Allison et al., 2002) that is both the ends show higher mortality, and the least mortality is in between. The disease conditions like cardiovascular and renal diseases, which are generally found to be associated with the higher values of BMI (over- weight), were all found to be positively related to high blood pressure. Risk of heart attack, heart failure, stroke and kidney disease, have been found to be increased with the increasing blood pressures (JNC7, 2003). Hypertension affects approximately one billion individuals worldwide (JNC7, 2003). Rates of hypertension have been shown to increase in traditional populations undergoing modernization and also among migrant populations from rural to urban habitats. Many different studies have shown that a number of factors are found to be responsible for higher incidence of hypertension (JNC7, 2003). The traditional rural population not following sedentary way of life don’t generally show higher incidence of hypertension. Altitude also affects blood pressure. Ascent to high altitude results in increase in blood pressure; but after some years of residence blood pressure tend to gradually decline, even falling below those observed at sea level. Both Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) are found to be lower in the high altitude native populations than in the low altitude native populations at high altitude (Clegg et. al., 1976; Hanna, 1999). Prevalence of hypertension is also lower in the higher altitude samples as also the incidence of chronic heart disease compared to the low altitude populations. (Hanna, 1999). There was a gradual reduction in SBP in lowlanders who remain for years at high altitude. The degree of decline in systemic BP is found to be a function of time at residence at altitude. The Andean evidence is strong in suggesting the above relationship. This observation is also observed in some other populations like Sherpas (Basu et. al., 1984), natives of Tien Shan and the Pamir (Mirrakhi- mov, 1978) and the Ambars region in Ethiopia (Beall, 1997). One study on Tibetans (Sun, 1986) points to a reverse relationship. Tibetans in Lhasa (high altitude) showed higher incidence of hypertension than the low altitude native Han migrants. In view of the above the incidence of hyper- tension and its association with altitude and nutri- tional status among adult Tibetans have been investigated in this study. MATERIALS AND METHODS Tibetans are a predominantly Mongoloid population inhabiting the central Tibetan Plateau. The central Tibetan Plateau is land locked and bounded on all sides by huge mountains ranges. Tibetan Plateau represents the world’s largest and highest landmass, with an average elevation of more than 4500m and supporting human populations up to 5000m. As a country, Tibet has been quite isolated from the rest of the world because of climate/geographical, cultural and political reasons resulting in very few anthropological studies on the populations of Tibet. Tibetans are believed to have lived at high altitudes for longer than other high-altitude populations of the Nutritional Status and Hypertension Among Tibetan Adults in India Vikal Tripathy, Kanhu Charan Satapathy and Ranjan Gupta