GeogRaphic and socioecoNomic Distribution of real‐world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India

Abstract

One‐fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti‐hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the “true BP control rate” should be performed using both clinic BP measurement and out‐of‐office BP measurement as the latter shows better prognosis for patients’ hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan‐India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.

Source of bias in home BP monitoring: Insight into the GRAND study protocol in India

“…

The authors read with great pleasure the protocol on surveillance of home blood pressure (BP) monitoring in India by Verma and associates. 1 Given the number of factors that may affect BP at home versus in office and diversity of the Indian population, they would like to share the following insight for future iterations of the protocol:1. There is significant variability in antihypertensive treatment options, access to care, medication adherence, and health literacy across India.

…”

“…The authors read with great pleasure the protocol on surveillance of home blood pressure (BP) monitoring in India by Verma and associates. 1 Given the number of factors that may affect BP at home versus in office and diversity of the Indian population, they would like to share the following insight for future iterations of the protocol: There is significant variability in antihypertensive treatment options, access to care, medication adherence, and health literacy across India. 2 While the study's inclusion criteria requires stable antihypertensive regimen for at least 3 months, how stability is defined should be detailed taking aforementioned sources of variability into account as that may affect accuracy of uncontrolled BP prevalence calculations.…”