IDF21-0145 Prevalence, awareness, treatment and control of hypertension among non-diabetics, prediabetics and diabetics in India

Abstract

Background: Hypertension is the most common co-morbidity among people with diabetes. Prehypertension, hypertension, prediabetes and diabetes increase the risk of cardiovascular disease (CVD) which is the number one cause of death among adult Indians. Aim: To estimate the prevalence, awareness, treatment and control of hypertension among adults with no diabetes, prediabetes and diabetes in India. Method: We conducted a cross-sectional study in 2018 among 12284 participants aged ≥30 years residing in epidemiologically transitioning representative population in rural and urban north (Sonipat) and south (Vizag) India. Participants were selected using a multistage cluster random sampling technique. Trained data collectors administered the questionnaire and trained phlebotomists collected blood samples to estimate fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Blood pressure (BP) was measured following standard guidelines. Prediabetes was defined as FPG between 100 and 125 mg/dl or HbA1C between 5.7% and 6.4%. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported diagnosis. Hypertension was defined as Systolic BP ≥140 mmHg or Diastolic BP ≥90 mmHg or self-reported diagnosis. Awareness was defined as self-reported physician diagnosed hypertension among prevalent cases. Treatment was defined as currently taking anti-hypertensive medication. Control was defined as participants with SBP<140 mmHg and DBP<90mmHg and on anti-hypertensive medication. Bivariate logistic regression was used to measure associations. Results: The mean (±SD) age was 49.2 (±12.6) years. Nearly half of them were residing in rural areas and were women. The age standardized prevalence of hypertension was 26.0% (95% CI: 25.1–26.8), 35.8% (34.9–36.7) and 48.6% (47.7–49.6) in participants with no diabetes, prediabetes and diabetes respectively. The prevalence of hypertension was higher in males compared to females and also increased with increase in wealth index in all the three groups. Percentage aware, treated and controlled is given in Table 1. People with diabetes were more likely to be aware of their hypertension status if they were females [OR: 1.4 (1.1–1.6)], urban residents [1.6 (1.3–2)], from Vizag site [2.2 (1.8–2.6)], belonged to highest quintile of wealth index [1.5 (1.1 - 2.1)] compared to lowest, never consumed tobacco [1.6 (1.3–2.1)] or alcohol [1.4 (1.1–1.7)], had a family history of hypertension [2.3 (1.8–2.9)], diabetes [1.5 (1.2–1.8)] or heart disease [2.2 (1.4–3.4)].Table 1Proportion (with 95% CI) of participants aware of hypertension diagnosis, treated and controlledNo diabetesPrediabetesDiabetesAwareness38.5 (35.8–41.2)42.7 (40.1–45.3)63.8 (61.0–66.5)Treatment74.8 (71.0–78.7)82.3 (79.2–85.4)90.3 (88.2–92.4)Control45.0 (39.8–50.2)43.9 (39.5–48.4)44.2 (40.4–48.0) Open table in a new tab Discussion: Hypertension is very high in people with prediabetes and diabetes and its awareness, treatment and control is sub-optimal. Tailored and culturally relevant interventions to improve hypertention awareness and management among people with diabetes is urgently needed along with screening for prediabetes among those with hypertension.