Status of hypertension control in urban slums of Central India : A Community health worker based two-year follow up

Abstract

Background: Hypertension is a leading cause of cardiovascular diseases its control is poor. There exists heterogeneity in levels of blood-pressure control among various population sub-groups. Present study conducted in framework of National Program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) in India, aims to estimate proportion of optimal blood pressure control and identify potential risk factors pertaining uncontrolled hypertension consequent to initial screening. Methods: We conceived a cohort of individuals with hypertension confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen Accredited Social Health Activists (ASHAs) were trained from within these urban slum communities. Individuals with hypertension were linked to primary care providers and followed-up for next two years. Obtaining optimal blood-pressure control (defined as SBP< 140 and DBP<90 mm of Hg) was a key outcome. Role of baseline anthropometric, and CVD risk factors was evaluated as predictors of blood-pressure control on univariate and multivariate analysis. Results: Of a total of 6174 individuals, 1571 (25.4%) had hypertension, of which 813 were previously known and 758 were newly detected during baseline survey. Two year follow up was completed for 1177 (74.9%). Blood-pressure was optimally controlled in 301 (26%) at baseline, and in 442 (38%) individuals at two years (absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical-inactivity, higher BMI and newly diagnosed hypertension were significantly associated with uncontrolled blood-pressure. Conclusions: In the current study we found about six of every ten individuals with hypertension were on-treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up. Key words: hypertension, optimal blood pressure control, community health worker, physical inactivity

Evidence for lower threshold for diagnosis of hypertension: inferences from an urban-slum cohort in India

“…In a previous study, with a diagnostic threshold of 140/90 mm Hg, we estimated that 25% of adults have hypertension. 33 This proportion would become about 44% with a lower threshold of 130/80 mm Hg. This increment is similar as in other settings, and lowering of threshold also increases the absolute number of individuals with blood-pressure unawareness, and those with white-coat hypertension.…”