Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: analysis of nationally-representative survey data.

Kath A Moser,George Davey Smith,Sutapa Agrawal,Shah Ebrahim,Yiru Guo

doi:10.1371/journal.pone.0086043

Abstract

BackgroundHypertension is a major contributing factor to the current epidemic of cardiovascular disease in India. Small studies suggest high, and increasing, prevalence especially in urban areas, with poor detection and management, but national data has been lacking. The aim of the current study was to use nationally-representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indian adults.MethodsUsing data on self-reported diagnosis and treatment, and blood pressure measurement, collected from 12,198 respondents aged 18+ in the 2007 WHO Study on Global Ageing and Adult Health in India, factors associated with prevalence, diagnosis and treatment of hypertension were investigated.Results22% men and 26% women had hypertension; prevalence increased steeply with body mass index (<18.5 kg/m2: 18% men, 21% women; 25-29.9 kg/m2: 35% men, 35% women), was higher in the least poor vs. poorest (men: odds ratio (95%CI) 1.82 (1.20 to 2.76); women: 1.40 (1.08 to 1.81)), urban vs. rural men (1.64 (1.19 to 2.25)), and men recently vs. never using alcohol (1.96 (1.40 to 2.76)). Over half the hypertension in women, and 70% in men, was undetected with particularly poor detection rates in young urban men, and in poorer households. Two-thirds of men and women with detected hypertension were treated. Two-thirds of women treated had their hypertension controlled, irrespective of urban/rural setting or wealth. Adequate blood pressure control was sub-optimal in urban men.ConclusionHypertension is very common in India, even among underweight adults and those of lower socioeconomic position. Improved detection is needed to reduce the burden of disease attributable to hypertension. Levels of treatment and control are relatively good, particularly in women, although urban men require more careful attention.

Highlights

Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India and many other lowand middle-income countries [1,2]
Hypertension tends to be inversely related to socioeconomic position in high income countries [7] with the opposite often being the case in low- and middle-income countries [8]
In the later stages of the epidemiological transition does the burden of chronic disease including hypertension shift from higher to lower socioeconomic groups [2,9]

Summary

Introduction

Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India and many other lowand middle-income countries [1,2]. The global burden of hypertension was estimated to be close to 1 billion adults in 2000, and predicted to increase to 1.56 billion by 2025 [3]. Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India. Increasing, prevalence especially in urban areas, with poor detection and management, but national data has been lacking. The aim of the current study was to use nationally-representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indian adults

Objectives

Methods

Results

Conclusion