Hypertension screening, awareness, treatment, and control in India: a nationally representative cross-sectional study among individuals aged 15 to 49 years

Research output: Contribution to journalArticle

Authors

  • Jonas Prenissl
  • Jennifer Manne-Goehler
  • Lindsay M Jaacks
  • Prabhakaran Dorairaj
  • Ashish Awasthi
  • Anne Christine Bischops
  • Rifat Atun
  • Till Bärnighausen
  • Sebastian Vollmer
  • Pascal Geldsetzer

Colleges, School and Institutes

Abstract

Background: Evidence on where in the hypertension care process individuals are lost to care, and how this varies among states and population groups in a country as large as India, is essential for the design of targeted interventions and to monitor progress. Yet, to date, there has not been a nationally representative analysis of the proportion of people who reach each step of the hypertension care process in India. This study aimed to determine i) the proportion of adults with hypertension who had been screened, diagnosed, treated, and achieved control, and ii) the variation of these care indicators among states and socio-demographic groups.

Methods and Findings: We used data from a nationally representative household survey carried out from January 20th 2015 to December 4th 2016 among individuals aged 15-49 years in all states and Union Territories of the country. The stages of the care process – computed among those with hypertension – were: i) having ever had your blood pressure (BP) measured (‘screened’), ii) having been diagnosed (‘aware’), iii) currently taking BP-lowering medication (‘treated’), and iv) reporting to be treated and not having a raised BP (‘controlled’). We disaggregated these stages by state, rural-urban residence, sex, age group, Body Mass Index (BMI), tobacco consumption, household wealth quintile, education, and marital status. 731,864 participants were included in the analysis. Hypertension prevalence was 18.1% (95% CI, 17.8% - 18.4%). Among those with hypertension, 76.1% (95% CI, 75.3% - 76.8%) had ever received a BP measurement, 44.7% (95% CI, 43.6% - 45.8%) were aware of their diagnosis, 13.3% (95% CI, 12.9% - 13.8%) were treated, and 7.9% (95% CI, 7.6% - 8.3%) had achieved control. Male sex, rural location, less household wealth, and not being married were associated with greater losses at each step of the care process. Between states, control among individuals with hypertension varied from 2.4% (95% CI, 1.7% - 3.3%) in Nagaland to 21.0% (95% CI, 9.8% - 39.6%) in Daman and Diu. At 38.0%, 28.8%, 28.4%, and 28.4%, respectively, Puducherry, Tamil Nadu, Sikkim, and Haryana had the highest proportion of all adults (whether hypertensive or not) in the sampled age range who had hypertension but did not achieve control. The main limitation of this study is that its results cannot be generalized to adults aged 50 years and older – the population group in which hypertension is most common.

Conclusions: Hypertension prevalence in India is high, but the proportions of adults with hypertension who are aware of their diagnosis, treated, and achieve control is low. Even after adjusting for a state’s economic development, there is large variation among states in health system performance in the management of hypertension. Improvements in access to hypertension diagnosis and treatment are especially important among men, in rural areas and populations with lower household wealth.

Details

Original languageEnglish
Article numbere1002801
Number of pages18
JournalPLoS Medicine
Volume16
Issue number5
Publication statusPublished - 3 May 2019