TWO DECADE'S TRENDS IN HYPERTENSION AMONG URBAN ADULT POPULATION OF EAST INDIAN COMMUNITY: OBSERVATION FROM A LONGITUDINAL COHORT

Abstract

Objective: Hypertension is one of the predominant major contributors of chronic disease burden among global non communicable diseases. The study evaluated trends in self-reported doctor diagnosed hypertension (DDH) and measured blood pressure (mBP) prevalence along with associated risk factors in an Indian urban population over 20 years. Design and method: Longitudinal cohort was established in 2001 with 3030 households based on the stratified multistage cluster sampling. Adult participants (N = 7275; Male = 3765, Female = 3510) were enrolled. Three household questionnaire surveys were performed in year 2001–02, 2011–12, 2018–19 with the same population size to determine DDH trend. Two representatives’ cross-sectional surveys were conducted (In 2014–15, n:5741, male = 2319, female = 3422; In 2018–19, n = 5741, male = 2204, female = 3537) to evaluate trends in hypertension based on the mBP value. Blood pressure and anthropometric data were also recorded according to the established protocol. mBP classification was derived from Joint National Committee (JNC-8) guideline. Results: Prevalence of DDH (%) in successive surveys increased from 9.70, 17.86, 22.67 and measured BP (%) among pre-hypertensive 32.12, 39.17, hypertension-stage1 14.41, 19.91, hypertension-stage2 7.05, 8.26 over the time. Gender specific prevalence of hypertension showed progressive rise of DDH [OR = 0.69, CI: 0.61,0.78, p < .0001]and mBP [In 2014, PreHTN: OR = 1.69, CI = 1.49, 1.91, p < .0001; HTNstg1: OR:1.43, CI = 1.22, 1.68, p < .0001, HTNstg2: OR = 1.44,CI = 1.17, 1.78, p = 0.0007; In 2018, PreHTN: OR = 2.04, CI = 1.79,2.32, p < .0001; HTNstg1: OR = 2.23, CI = 1.91,2.60, p < .0001; HTNstg2: OR = 1.948, CI = 1.58,2.40, p < .0001] in men when compared to women. Association of DDH with smoking [In 2001–02, OR = 0.62, CI = 0.52,0.74, p < .0001; In 2018–19, OR = 0.75, CI = 0.63, 0.90, p = .0020] and duration of sleep (>8 hrs.) [In 2001–02, OR = 0.71, CI = 0.61, 0.82, p < .0001; In 2018–19, OR = 1.18, CI = 1.01, 1.38, p = 0.0401] established. Trend revealed higher education was a lower risk of hypertension. Increasing trends were observed across all hypertension categories among obese compared to normal. Conclusions: In mBP group, HTNstg2 prevalence has increased marginally over 7 years, among remaining groups increasing prevalence trend was unequivocal. Most of the long-established reversible risk factors association prevalence also increasing. Higher education having lower risk may well suggest importance of increased awareness. A strategy to reverse the rising trend of the chronic disease burden is required.