Hypertension Diagnosis, Treatment, and Control in India

Abstract

ImportanceHypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum—including diagnosis, treatment, and control—in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hypertension.ObjectiveTo examine the hypertension care continuum in India among individuals aged 18 to 98 years.Design, Setting, and ParticipantsThe nationally representative Fifth National Family Health Survey study was conducted in 2 phases from June 17, 2019, to March 21, 2020, and from November 21, 2020, to April 30, 2021, among 1 895 297 individuals in 28 states, 8 union territories, and 707 districts of India.ExposuresDistrict and state of residence, urban classification, age (18-39, 40-64, and ≥65 years), sex, and household wealth quintile.Main Outcomes and MeasuresHypertension was defined as a self-reported diagnosis or a newly measured blood pressure of 140/90 mm Hg or more. The proportion of individuals diagnosed (self-reported), the proportion of individuals treated among those diagnosed (self-reported medication use), and the proportion of individuals with blood pressure control among those treated (blood pressure <140/90 mm Hg [aged 18-79 years] or <150/90 mm Hg [aged ≥80 years]) were calculated based on national guidelines. Age-standardized estimates of treatment and control were also provided among the total with hypertension. To assess differences in the care continuum between or within states (ie, between districts), the variance was partitioned using generalized linear mixed models.ResultsOf the 1 691 036 adult respondents (52.6% women; mean [SD] age, 41.6 [16.5] years), 28.1% (95% CI, 27.9%-28.3%) had hypertension, of whom 36.9% (95% CI, 36.4%-37.3%) received a diagnosis. Among those who received a diagnosis, 44.7% (95% CI, 44.1%-45.3%) reported taking medication (corresponding to 17.7% [95% CI, 17.5%-17.9%] of the total with hypertension). Among those treated, 52.5% (95% CI, 51.7%-53.4%) had blood pressure control (corresponding to 8.5% [95% CI, 8.3%-8.6%] of the total with hypertension). There were substantial variations across districts in blood pressure diagnosis (range, 6.3%-77.5%), treatment (range, 8.7%-97.1%), and control (range, 2.7%-76.6%). Large proportions of the variation in hypertension diagnosis (94.7%), treatment (93.6%), and control (97.3%) were within states, not just between states.Conclusions and RelevanceIn this cross-sectional survey study of Indian adults, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control. National mean values hide considerable state-level and district-level variation in the care continuum, suggesting the need for targeted, decentralized solutions to improve the hypertension care continuum in India.

The association of hypertension among married Indian couples: a nationally representative cross-sectional study

“…Spousal concordance in the prevalence of hypertension, with greater co-occurrence than what is statistically expected, suggests that couple-or family-centered interventions may be useful for improving screening and diagnosis efforts, especially since over half of hypertension in India remains undiagnosed [5][6][7]. Such an approach may improve the e ciency of screening, since guidelines presently incorporate only family history of rst-degree relatives (mother, father, sister, brother), but not that of other residents of the household (spouse, children) when screening for disease [32].…”

“…Although current national guidelines recommend opportunistic screening of all adults and universal screening for those 30 years and older, only 2 in 5 with hypertension are diagnosed [2][3][4][5][6][7]. Married couples often share chronic disease status, a phenomenon referred to in the literature as spousal concordance, which is only partly explained by concordance of individual risk factors [8][9][10].…”

Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India

“…Additionally, only 45% among the diagnosed reported taking medication, and of these treated individuals, only 53% had their blood pressure (BP) under control. 5 Due to population aging, the number of people in need of hypertension care in India is expected to more than double over the coming decades making the improvement of hypertension control an urgent health priority. 6 To address the growing burden of cardiometabolic diseases, the Indian government initiated "The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke" in 2010, followed by the "National Multisectoral Action Plan for Prevention and Control of Common Non-Communicable Diseases 2017-2022" in 2013, and the "National Programme for Prevention and Control of Non-Communicable Diseases" in 2023.…”

The association of hypertension among married Indian couples: a nationally representative cross-sectional study

“…India has the second largest population with hypertension in the world of over 220 million people 1 . Although current national guidelines recommend opportunistic screening of all adults and universal screening for those 30 years and older, only 2 in 5 with hypertension are diagnosed 2 – 7 . Married couples often share chronic disease status, a phenomenon referred to in the literature as spousal concordance, which is only partly explained by concordance of individual risk factors 8 – 10 .…”