Hypertension In India Research Articles

Predictors of hypertension among pregnant and nonpregnant Indian women

Background: Hypertension (HTN) is emerging as a leading cause of many noncommunicable diseases, including cardiovascular diseases and stroke. Our analysis estimates the proportion of women aged 15–49 years with HTN for nonpregnant and pregnant women in India and its associated sociodemographic women and dietary/behavioral factors. Methods: National cross-sectional data from the National Family Health Survey-4, conducted between 2015 and 2016, were used. The primary outcome of the analysis was HTN. HTN was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥ 90 mmHg. Results: We estimated the proportion of women with HTN and used multivariable logistic regression to explore associated factors. Nationally, 16.89% (95% confidence interval [CI] = 16.72–17.06) and 11.39% (95% CI = 10.93–11.87) of nonpregnant and pregnant women had HTN. Nonpregnant and pregnant women who consume milk or curd weekly and occasionally were associated with lower odds of being HTN compared to daily eaters. Nonpregnant women who consume green leafy occasionally (adjusted odds ratio [aOR] = 0.91, 95% CI = 0.84–0.98) had lower odds of being HTN. Pregnant women who consume pulses or beans occasionally (aOR = 1.40, 95% CI = 1.06–1.84) had higher odds of being HTN compared to daily eaters. Conclusion: We conclude both nonpregnant and pregnant women who consume milk or curd weekly and occasionally are less likely to have HTN. However, proper dietary food strategies are needed. Our findings suggest that there is a need to evaluate interventions targeted to study an appropriate diet to control HTN in India.

Abstract MP64: Estimated Impact Of Public Health System Reforms To Increase Hypertension Treatment Coverage In India

Background: Approaches to scale up hypertension (HTN) treatment are needed in India, where only ~10% of individuals with HTN have controlled blood pressure. Objective: Estimate the current HTN treatment capacity of the public health system in India and model the effects of selected health system reform options. Methods: Using constrained optimization models, we estimated the HTN treatment capacity and salary costs of HTN-treating staff within the public health system; and simulated the potential effects of 1) increased workforce, 2) greater task sharing, and/or 3) reduced visit frequency (quarterly) vs the common practice of monthly visits for prescription refills. Results: An estimated 8% of all adults with HTN could be treated in the status quo (current number of health workers, no further task sharing, and monthly visits) (Figure). Treating 70% of adults with HTN with monthly visits without greater task sharing could require an additional 1.6 million staff, with ~200 billion ₹ (≈US$2.7 billion)) in additional annual salaries. Greater task sharing was estimated to allow the current workforce to treat ~25% of individuals with HTN with monthly visits. Quarterly visits (i.e., longer prescription periods) together with greater task sharing could allow the current workforce to treat ~70% of patients with HTN in India. Conclusion: Expanding HTN treatment coverage through workforce expansion alone will require substantial human and financial resources. The combination of greater task sharing and quarterly visits could increase the coverage of HTN treatment to ~70% of adults with HTN in India, without any expansion of the current workforce of the public health system.

MULTIDISCIPLINARY CONSENSUS ON THE MANAGEMENT OF UNCONTROLLED HYPERTENSION IN INDIA

Objective: Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in Uncontrolled Hypertension (UHT). The prevalence of UHT is high in India, with only about 9–20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT Design and method: A Multidisciplinary Panel, comprising of specialists in Cardiology, Nephrology and Internal Medicine, was convened to address the diagnosis and management of UHT in the Indian population. The Panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting Results: • UHT can be defined as the inability to achieve BP control with the use of three medications in optimal doses, with three BP readings taken in three weeks. The condition can be further classified as causative and therapeutic UHT. • The high prevalence of UHT was attributed to the high salt content in the Indian diet (particularly from preserved foods), a lack of awareness and poor adherence to medication. • Diagnosis of UHT involves screening for the following: sleep apnea, cardiac and renal abnormalities, and hyperaldosteronism. Investigations recommended were micro-albumin, blood sugar, kidney function tests, urinalysis, echocardiogram, 24-hour ambulatory BP reading, waist-to-hip ratio, serum potassium and lipid profile. • A detailed algorithm was proposed for management of UHT based on its causes, specific to the presence of cardiac/renal disease, and co-morbidities like Diabetes Mellitus. Recommendations from the panel can rationalize the clinicians’ approach in the management of UHT in India. • A prevention strategy for UHT requires the participation and joint responsibility of clinicians, patients and policymakers. Conclusions: Appropriate treatment recommendations by clinicians, with simplified medication regimens can help improve patient adherence. Identification and reversal of lifestyle factors by patients through education and counselling, and better health literacy through public health campaigns can aid the control of HT in India.

Prevalence, risk factors and awareness of hypertension in India: a systematic review

Indians have high rates of cardiovascular disease. Hypertension (HTN) is an important modifiable risk factor. There are no comprehensive reviews or a nationally representative study of the burden, treatments and outcomes of HTN in India. A systematic review was conducted to study the trends in prevalence, risk factors and awareness of HTN in India. We searched MEDLINE from January 1969 to July 2011 using prespecified medical subject heading (MeSH) terms. Of 3372 studies, 206 were included for data extraction and 174 were observational studies. Prevalence was reported in 48 studies with sample size varying from 206 to 167 331. A significant positive trend (P<0.0001) was observed over time in prevalence of HTN by region and gender. Awareness and control of HTN (11 studies) ranged from 20 to 54% and 7.5 to 25%, respectively. Increasing age, body mass index, smoking, diabetes and extra salt intake were common risk factors. In conclusion, from this systematic review, we record an increasing trend in prevalence of HTN in India by region and gender. The awareness of HTN in India is low with suboptimal control rates. There are few long-term studies to assess outcomes. Good quality long-term studies will help to understand HTN better and implement effective prevention and management programs.