Background: Hypertension is a significant contributor to mortality in India. This systematic review and meta-analysis aimed to understand the overall hypertension control rate in India, differences across sex and regions, and changes over time.
Methods: Community-based, non-interventional studies published between 2001 and 2020 were searched in PubMed, Embase, and Web of Science. Modified New Castle-Ottawa scales was used to assess the risk of bias. We conducted a random-effects meta-analysis to provide summary estimates by including 29 studies that had a minimum sample size of 100 each. We also conducted subgroup analysis and meta-regression to explore changes in control rates over years and to explain the heterogeneity.
Results: The systematic review included 170,631 hypertensive patients. The overall control rate was 33.2% (95% CI-27.9,38.6) with substantial heterogeneity, I2=99.1 % (95% CI-98.9,99.2; p <0.001). Subgroup analysis showed that hypertension control rates did not improve over the years (35.8% in 2011-2020 versus 29.6% in 2001-2010, p=0.23) and did not vary between males and females (34.2% for females and 28.2% for males, p=0.23). Control rates were significantly higher in the south region compared to other regions. Meta-regression model with sex, region, study period, and an interaction term for region and period of the study explained 76.5% of heterogeneity. Very few studies analyzed relevant factors that are associated with adequate control.
Conclusion: Hypertension is adequately controlled only among one-third of patients in India. India needs more studies at community levels to understand the health system and socioeconomic factors that determine uncontrolled hypertension in India.
PROSPERO registration: CRD42021267973
