Multi-morbidity and blood pressure control: Results of a cross-sectional study among school teachers in Kerala, India

Mini, G. K.; Mohan, Malu; Sarma, P. S.; Thankappan, KR

doi:10.4103/ijph.ijph_1236_20

Cited by 7 publications

(10 citation statements)

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“…The overall control of hypertension was suboptimal even among those reporting taking antihypertensive treatment (36.1%) suggestive of the presence of clinical inertia or failure of intensification of therapy by physicians despite persistently poorly controlled blood pressure levels. This proportion of patients with controlled blood pressure is lower than that reported in studies from Chennai (45.9%) [ 50 ], while greater than Kerala (32.1%) [ 51 ] and Kolkata (26%) [ 30 ] but indicative of a nationally prevalent problem. Another study conducted in urban slums of Kolkata among patients with hypertension reported that patients adherent to antihypertensive medications were 1.71 times more likely to achieve adequate blood pressure control compared to non-adherent patients, a finding similar to the present study [ 52 ].…”

Section: Discussioncontrasting

confidence: 56%

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

Singh,

Basu,

Lalwani

et al. 2023

BMC Public Health

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Background Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. Methods This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. Results We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). Conclusions Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.

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Section: Discussioncontrasting

confidence: 56%

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

Singh,

Basu,

Lalwani

et al. 2023

BMC Public Health

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“…Another study conducted by Sarkar et al 12 in 31 676 patients with hypertension in primary care in the UK, found that 16 140 (51 %) had multimorbidity, and hypertensive patients with multimorbidity had lower BP than those with hypertension alone. Mini et al 16 also reported that blood pressure control was better in participants who reported any comorbidity (OR = 2.37, 95%CI 1.51-3.71) compared to those who did not report any. However, several other studies reported the opposite findings—people with more comorbidities had poorer management and control of hypertension.…”

Section: Discussionmentioning

confidence: 95%

“…10,11 Several studies have examined the impact of multimorbidity on BP control, and there has been conflicting evidence on the association between multimorbidity and hypertension control. [12][13][14][15][16][17] While some studies show that the presence of multimorbidity was positively associated with BP control, 12,13,16 other studies suggested that people with more comorbidities had poorer management and control of hypertension. 15,17 There is minimal evidence of this association in the Canadian population.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada

Nguyen,

Kalia,

Hanlon

et al. 2023

J Prim Care Community Health

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Background: There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. Methods: This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. Results: A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. Conclusion: We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.

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“…Studies have highlighted the increasing risk of chronic conditions associated with excess weight. For instance, a study conducted in Kerala found a positive association between obesity and the prevalence of hypertension and type 2 diabetes among women [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

District-level heterogeneity in overweight or obesity among women of reproductive age: A geo-spatial analysis in India

Kundu,

Sharma,

Singh

et al. 2023

PLoS ONE

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Background Globally by 2030, 38% of the world’s population would be overweight, and another 20% would be obese. This has led to rising concerns regarding how swiftly and substantially the world is moving towards this epidemic of "globesity". India too is facing an increased burden of overweight and obese population. The changing dietary patterns are significantly associated with the increasing prevalence of overweight/obesity and related complications, especially among women. Hence, the present study aims to observe the spatial patterns of overweight or obesity among women in reproductive age group in India and factors associated with it. Methods The study analyzed data from a cross-sectional nationwide household survey, i.e. National Family Health Survey (NFHS-4), 2015–16. The primary outcome variable of this study was overweight/obesity among reproductive-age women, which was measured through the body mass index (BMI) of the women. Bivariate and multivariate logistic regression analysis was used to analyze the data. Additionally, for spatial analysis in terms of overweight/obesity among women in India, univariate and bivariate Moran’s I index measurements were used along with the usage of spatial regression models. Results The value of spatial-autocorrelation for overweight or obese was 0.64, which depicts the moderately high prevalence of the overweight/obesity coverage over districts of India. The overall prevalence overweight/obesity among women in India is around 25% and higher proportion of women from urban areas (37.8%), and non-poor (33.4%) economic group reported to be overweight or obese. From spatial lag model, the lag coefficient was found to be 0.28, implying that a change in the prevalence of overweight/obesity among women in a certain district may statistically lag the prevalence of overweight/obesity by 28% in the neighbouring districts. There were significantly high clustering of overweight/obese women and non-poor wealth quintiles in 132 districts, mainly from states of Punjab, Haryana, Gujarat, Maharashtra, Kerala, Tamil Nadu, Karnataka and Andhra Pradesh. Additionally, there was high-high clustering of overweight/obese women and those who ever had caesarean in 82 districts, mostly from Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. Conclusion The spatial patterns on the prevalence of overweight and obesity in India show that the women belonging to the southern states’ districts are more overweight or obese in comparison to other states. The determinants like older age, higher education, urban residence, higher economic status are the key factors contributing to the prevalence of overweight or obesity among women in the reproductive age group. The study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status, to reduce the risks of health consequences due to overweight and obesity.

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Multi-morbidity and blood pressure control: Results of a cross-sectional study among school teachers in Kerala, India

Cited by 7 publications

References 0 publications

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada

District-level heterogeneity in overweight or obesity among women of reproductive age: A geo-spatial analysis in India

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