Hypertension diagnosis, treatment, and control in India: nationally representative results from 1.69 million adults, 2019-2021
Jithin Sam Varghese (1,2), Nikhil Srinivasapura Venkateshmurthy (3), Nikkil Sudharsanan (4,5), Panniyammakal Jeemon (6), Shivani A Patel (1,2), Harsha Thirumurthy (7), Ambuj Roy (8), Nikhil Tandon (9), KM Venkat Narayan (1,2), Dorairaj Prabhakaran (3,10), Mohammed K. Ali (1,2,11)
1 Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA.
2 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
3 Public Health Foundation of India, New Delhi, India
4 Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
5 Heidelberg Institute of Global Health, Heidelberg University, Germany
6 Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
7 Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, USA
8 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
9 Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
10 Center for Chronic Disease Control, New Delhi, India
11 Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA
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Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum in India –including diagnosis, treatment, and control– did not assess district level variation. Local data are critical for planning, implementation, and monitoring efforts to curb hypertension burdens.
To characterize the hypertension care continuum in India among individuals aged 18-98 years old at national, state, and district levels and by socio-demographic group.
Nationally-representative survey, 2019-21
28 states, 8 union territories, and 707 districts of India
1,895,297 individuals in the Fifth National Family Health Survey (NFHS-5)
District and state of residence; urban classification; age (18-39, 40-64, ≥65 years); sex; and household wealth quintile
Hypertension was defined as self-reported diagnosis or newly measured blood pressure ≥140/90 mmHg. Among those with hypertension, we calculated the proportion diagnosed (self-reported). Among those with diagnosed hypertension, we computed the proportion treated (self-reported medication use). Among those treated, we calculated the proportion controlled (BP <140/90 mmHg [20-80 years] or <150/90 mmHg [>80 years]) based on national guidelines. Estimates were also provided among the total with hypertension. To assess differences in the care continuum between or within states (i.e. between districts), we partitioned the variance at both levels using linear mixed models.
Among 1,691,109 adult respondents nationally (52.6% female; mean age: 41.6 years), 28.2% [95%CI: 28.0-28.4] had hypertension, of whom, 36.7% [36.3- 37.2] were diagnosed. Among those diagnosed, 44.7% [44.1-45.3] reported taking medication (17.7% [17.5-17.9] of total with hypertension). Among those treated, 52.3% [51.4-53.1] had blood pressure control (9.1% [8.9-9.2] of total with hypertension). There were substantial variations across districts in diagnosis [range: 6.3–77.5%], treatment [8.7–97.1%] and control [2.7–76.6%]. Notably, large proportions of the variation in hypertension diagnosis (53.7%), treatment (32.8%), and control (57.7%) were within states, not just between states.
In India, more than 1 in 4 people have hypertension, and of these, only 1 in 3 are diagnosed, less than 1 in 5 are treated, and only 1 in 11 controlled. National averages hide considerable state- and district-level variation in the care continuum, implying the need for targeted, decentralized solutions to improve the hypertension care continuum in India.