India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics

Kaur, Prabhdeep; Kunwar, Abhishek; Sharma, Meenakshi; Mitra, Jhilam; Das, Chinmoyee; Swasticharan, Leimapokpam; Chakma, Tapas; Bangar, Sampada Dipak; Venkatasamy, Vettrichelvan; Dharamsoth, Raviteja; Purohit, Saurabh; Tayade, Sadhana; Singh, Gurdeep; Bitragunta, Sailaja; Durgad, Kiran; Das, Bidisha; Dar, Sunil; Bharadwaj, Rupali; Joshi, Chakshu; Bharadwaj, Vishwajit; Khedkar, Suhas; Chenji, Sravan; Reddy, S. V.; Sreedhar, Chintala; Ganeshkumar, P.; Kasiviswanathan, Savitha; Viswanathan, Vidhya; Uike, Pankaj V; Gaigaware, Pooja; Yadav, Sneha; Dhaliwal, Rupinder Singh; Ramakrishnan, Sivasubramanian; Tullu, Fikru; Bhargava, Balram

doi:10.1111/jch.14141

Cited by 45 publications

(43 citation statements)

References 12 publications

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“…67 The previous meta-analysis from India reported significant differences in rural and urban on awareness and control levels while no significant difference was noted for percentage treated. 61 In our review we found two studies that reported no difference between urban and rural population while four studies reported rural populations to have poorer control.…”

Section: Discussionmentioning

confidence: 80%

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Koya

Pilakkadavath

Wilson³

et al. 2022

Preprint

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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

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Section: Discussionmentioning

confidence: 80%

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Koya

Pilakkadavath

Wilson³

et al. 2022

Preprint

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“…29 However, the India Hypertension Control Initiative – a programme supported by the government and WHO – which includes opportunistic screening at public primary care and lower secondary care facilities was launched in only five states in 2017. 30 Our estimates point to the potential impact of such a programme and give urgency to plans to implement it in all states by 2023. The results also suggest that the impact would be even greater if private facilities also implemented screening or if people shifted their health-care utilization towards the public sector.…”

Section: Discussionmentioning

confidence: 90%

Missed opportunities for hypertension screening: a cross-sectional study, India

Mohanty¹,

Upadhyay²,

Shekhar³

et al. 2022

Bull World Health Org

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Objective To assess missed opportunities for hypertension screening at health facilities in India and describe systematic differences in these missed opportunities across states and sociodemographic groups. Methods We used nationally representative survey data from the 2017–2018 Longitudinal Ageing Study in India to estimate the proportion of adults aged 45 years or older identified with hypertension and who had not been diagnosed with hypertension despite having visited a health facility during the previous 12 months. We estimated age–sex adjusted proportions of missed opportunities to diagnose hypertension, as well as actual and potential proportions of diagnosis, by sociodemographic characteristics and for each state. Findings Among those identified as having hypertension, 22.6% (95% confidence interval, CI: 21.3 to 23.8) had not been diagnosed despite having recently visited a health facility. If these opportunities had been realized, the prevalence of diagnosed hypertension would have increased from 54.8% (95% CI: 53.5 to 56.1) to 77.3% (95% CI: 76.2 to 78.5). Missed opportunities for diagnosis were more common among individuals who were poorer ( P = 0.001), less educated ( P < 0.001), male ( P < 0.001), rural ( P < 0.001), Hindu ( P = 0.001), living alone ( P = 0.028) and working ( P < 0.001). Missed opportunities for diagnosis were more common at private than at public health facilities ( P < 0.001) and varied widely across states ( P < 0.001). Conclusion Opportunistic screening for hypertension has the potential to significantly increase detection of the condition and reduce sociodemographic and geographic inequalities in its diagnosis. Such screening could be a first step towards more effective and equitable hypertension treatment and control.

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“…However, the India Hypertension Control Initiative (IHCI) was launched—in 5 states—only in November 2017. An observational study found that BP control achieved by public health facility patients increased from 26% at registration in the IHCI to 60% at follow-up [ 26 ]. Our findings can help identify states and sociodemographic groups to be targeted as this program is rolled out over the country.…”

Section: Discussionmentioning

confidence: 99%

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

et al. 2021

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Background Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India. Methods and findings We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement ≥140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis (“aware”); (ii) reported taking medication or being under salt/diet restriction to control BP (“treated”); and (iii) had measured systolic BP <140 and diastolic BP <90 (“controlled”). We estimated age–sex adjusted hypertension prevalence and rates of ATC by consumption quintile, education, age, sex, urban–rural, caste, religion, marital status, living arrangement, employment status, health insurance, and state. We used concentration indices to measure socioeconomic inequalities and multivariable logistic regression to estimate fully adjusted differences in these outcomes. Study limitations included reliance on BP measurement on a single occasion, missing measurements of BP for some participants, and lack of data on nonadherence to medication. The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age–sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth. Conclusions Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups.

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India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics

Cited by 45 publications

References 12 publications

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Missed opportunities for hypertension screening: a cross-sectional study, India

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

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