Existence of Rule of Halves in Hypertension: an Exploratory Analysis in an Indian Village

Abstract

Introduction:India is a country in transition, the population is graying and the non communicable diseases are rising. In the rural areas of India, the detection of hypertension is poor because of limited healthcare facilities and poor awareness among the people. In one such village, Mirzapur, adopted by the Aligarh Muslim University, there is a planned project to control hypertension in the villages through some innovative approaches. This study was the assessment phase of this project for mass management of hypertension to steer and guide the next phase of the project.Aim:The main objectives of this study were: to determine the prevalence of hypertension in residents ≥ 40 years in Mirzapur village, Aligarh, and, to assess the presence of rule of halves in hypertensionResults and Discussion:The present study in residents more than 40 years of age in the Mirzapur village in Aligarh found that the prevalence of hypertension in the study population was 41.9%, with a higher prevalence in older age groups. The mean blood pressure of the study population was found to be 100.03±13.17 mm Hg. The high prevalence reported in the present study reflects and reaffirms the increasing trend of hypertension in not only the urban, but also rural India, at least in the older age group. The problem of hypertension, due to its silent and asymptomatic nature, frequently depicts a rule of halves in places with weaker health system and an equally weaker health awareness and information among populations and the same is true for this village.Conclusion:There is an urgent need to conduct similar researches in other adopted villages of the country for the sake of inclusive development to find the exact burden of this silent and asymptomatic killer. More importantly, there is a need to find innovative solutions to combat the problem of hypertension detection and management.

Is rule of halves still an occurrence in South India

“…Another study conducted in the rural village of Aligarh district of Uttar Pradesh of India reported the awareness regarding hypertension to be 40.3% among adults of more than 40 years. [ 7 ] These two studies from south and north India had concluded that rule of halves is still prevalent in India scenario; however, our study findings are similar as far as the awareness regarding hypertension goes. We found that once a person who is hypertensive comes to the fold of health-care system in Puducherry, on treatment and compliance to treatment increases significantly (at least two-thirds).…”

“…Similarly, the proportions of hypertensives started on regular treatment also more in developed countries (70%–85%) compared to developing nations (29%–50%). [ 2 7 13 14 15 16 17 18 19 20 ]…”

“…This phenomena has been described as the “rule of halves” and was coined in 1970s in the America,[ 4 ] was reported in Scotland in the 1990s,[ 5 ] and has been reported previously from some parts of India. [ 6 7 ] Early detection through surveillance, increasing the access to primary care for hypertension is proposed to be an urgent measure in many international agendas, including the recent United Nations high-level meeting on noncommunicable diseases (NCDs). [ 8 ] In India also, recently, major thrust is being given to early diagnosis and treatment for NCD under the realm of National Programme on Prevention and Control of Cancer, Diabetes, Cardio Vascular Disease and Stroke (NPCDCS).…”

A systematic review on association between smokeless tobacco & cardiovascular diseases

“…Hypertension and smokeless tobacco use : HTN, an important risk factor for death and morbidity globally, is one of the major causes of ischaemic heart disease, stroke and heart failure 65 66 67 . For developing countries like India, rule of halves 68 , i.e ., half of the hypertensives are undetected, half of those detected are untreated and half of treated are not well controlled is still valid and poses a significant challenge for control of HTN and incident cardiovascular diseases 68 69 .…”

The hidden facets of hypertension among workers

“…The 'Rule of Halves' indicates that 50% of the hypertensive cases are undetected; 50% of those detected are not treated, and 50% of those treated are not controlled (15). In support, 17% and 15% of the SOs and MAs in the study were newly diagnosed; and of those detected, 13% and 15% were on treatment for hypertension; and of those treated, 8.8% and 6.6% were currently on treatment.…”