The prevalence of hypertension is high in India, but the proportion of adults who are aware of their medical condition and are treated to achieve control is low, reveals a recent study. The study entitled “Hypertension screening, awareness, treatment, and control in India: A nationally representative cross-sectional study among individuals aged 15 to 49 years” was published in the PLOS Medicine journal this week. The researchers raise an urgent need for improvement in creating awareness on hypertension, care and control for all Indians.
The research involved 731,864 individuals aged 15-49 years, which covered each district of 29 states and 7 union territories of India. Pregnant women were excluded from the cohort. The study mainly evaluated the number of people who had had their blood pressure (BP) checked before the survey, those who had been diagnosed (aware) with BP, those who are under medication of lowering BP, and those reported to have had their BP under control.
The findings of the study point out that the proportion of those who never had their BP measured was high (76%). Less than half of the individuals (45%) had been diagnosed with hypertension. The study also highlighted that less than 1 in 7 (13%) reported to be currently taking hypertensive medication and less than 1 in 10 (8%) had their blood pressure under control.
The research showed a huge variation in state-level hypertension screening. Screening of hypertensive individuals was lowest in Madhya Pradesh (61.3%) and highest in Haryana (93.5%). Awareness level on BP was lowest in Chhattisgarh (22.1%) and highest in Puducherry (80.5%). 27 major state/union territories have blood pressure control rates below 10%. Daman and Diu were the highest, but still only 1 in 5 adults there are under control.
The study also found that adults living in rural areas, especially males from the poor household were even less likely to receive the care they need. The study revealed that only 5.3% of hypertensive men and 10.9% of hypertensive women aged 15-49 years have their blood pressure under control (by taking proper medication). Men showed to have a higher prevalence of hypertension (19%) compared to women (17.2%).
The highest absolute losses to care for hypertension occurred at the awareness and treatment stages, with a large relative loss at the treatment stage (70.3%). While improvements are needed along with the entire hypertension care cascade, the findings stress on a need for intervention that focuses on the awareness and treatment steps of the cascade.
“Detection of hypertension is straightforward, treatments are simple yet effective, and hence hypertension can be easily controlled. Control of hypertension prevents future stroke, heart attacks and deaths. However, it is an unfortunate paradox that India does not perform well in any of the measures of detection, treatment and control,” said Dorairaj Prabhakaran, vice president, Research and Policy, Public Health Foundation of India (PBFI) in a press release.
“While people do not usually notice that they have high blood pressure, the condition raises the risk of heart attacks and strokes substantially. Scaling up screening and treatment for high blood pressure is feasible because the condition is easy to test for and inexpensive to treat. Such a scale-up could result in huge benefits for population health in India.” said author Pascal Geldsetzer from Harvard T.H. Chan School of Public Health.
“Hypertension may not have any symptoms, diagnosis in the early phase is untapped due lack of awareness and regular medical checkups. Hypertension can be avoided with regular checkups and lifestyle modifications. India needs to focus on this silent killer to reduce preventable premature morbidity and mortality burden due to cardiovascular diseases.” said author Ashish Awasthi, Assistant Professor at PBFI.
However, the major drawback of the study is that it cannot be generalized to adults aged 50 and above which involve a major the population of hypertensive individuals.
The study was conducted by the Public Health Foundation of India (PHFI), Harvard T.H. Chan School of Public Health, Heidelberg Institute of Global Health, the University of Birmingham and the University of Gottingen, and was based on data from National Health and Family Survey (NFHS-4, 2015-16).