Hypertension: How its prevalence, diagnosis, control, and treatment varies across India

What does the study show about hypertension care in India?

The national level data reveals what doctors across the country already know — a large proportion of those with hypertension do not get diagnosed, a large proportion of those who are diagnosed do not initiate treatment, and a large proportion of those who start treatment aren’t able to control their blood pressure. Only one in three receives a diagnosis, one in five gets treated, and one in twelve achieves blood pressure control.

The interesting finding is the inter-state and inter-district variability of the different levels of the continuum of care.

At state level:

The study found that the prevalence of hypertension was similar among the southern states but higher than the national average — 29.9% of the population in the southern states as compared to 26.8% across India. The proportion of people diagnosed with hypertension in the southern states was similar to the rest of India. However, the proportion of people on treatment and with hypertension under control was higher in these states, the study showed.

At district level:

Not only at the state level, there were significant variations within districts, too. The researchers cited the example of two states to demonstrate this.

In Meghalaya, the prevalence of hypertension was similar in the districts of Garo Hills (21.8%), Jaintia Hills (19.8%), and Khasi Hills (23.1%). However, the proportion of those diagnosed was lower in Garo Hills at 18.6% compared to 29.4% in Khasi Hills and 41.1% in Janitia Hills.

In Karnataka, four districts — Chikmagalur, Shimoga, Udupi, and Chitradurga — have a similar prevalence of hypertension, but the proportion of people treated and successfully controlled it was higher in Chikmagalur and Udupi.

Source: Study published in JAMA

How do age, gender, and education come into play?

Even at the national level, there were significant variations in the four levels of the continuum of care depending on the gender, age, socio-economic conditions, and education level of the person.

While it is well known that men are more likely to have hypertension as compared to women, surprisingly, the data showed that women were much more likely to be diagnosed, be on treatment, and have their blood pressure under control.

The prevalence, diagnosis, treatment, and control were all higher among those over the age of 65 years as compared to youngsters. When it comes to socio-economic conditions, the prevalence, diagnosis, treatment, and control of hypertension was found to be highest among the wealthiest fifth of the population.

While the prevalence of hypertension was similar among those who had no schooling and those who had passed class 11, diagnosis, treatment, and control were higher among those who had completed schooling.

Why is it necessary to look at the inter-state and inter-district variability?

This district-level break-up of data can help state governments plan where and which level of care needs more resources, according to Dr Nikhil Tandon, one of the authors of the paper and professor of endocrinology and metabolism at the All India Institute of Medical Sciences, Delhi.

He said: “It is essential that healthcare systems be planned differently for the management of chronic conditions such as hypertension as compared to an acute disease. For an acute disease, the patient is likely to seek out care, and the treatment is also finite. Once they seek care and are prescribed medicines, they are likely to take them for the recommended duration because they want to feel better. But we know this does not happen with hypertension.”

For example, in a district where medicines are not available at regular intervals, the proportion of treatment is likely to be poor. The local government then has to ensure that medicines are available regularly and at centres close to people’s homes. Another way is to push the digitisation of records, which can help health workers ensure regular follow-ups for adjusting dosages of medicines.

For hypertension, Dr Tandon said, continuum of care is very important and not just the screening and diagnosis. “This data will help local governments understand where the problem lies — whether there is a high prevalence in a certain district, whether a particular district needs more screening or diagnostic facilities, whether medicines are accessible and available at regular periods.”

What needs to be done to control hypertension in India?

A recently released WHO report on hypertension said nearly 4.6 million deaths can be averted in India by 2040 if just half of the hypertensives were able to control their blood pressure. To tackle the issue, the government this year launched an ambitious initiative to put 75 million people with hypertension or diabetes on treatment by 2025.

Controlling hypertension, however, would not merely require an increase in infrastructure but a focus on active screening of people, putting them off treatment, ensuring the availability of medicine close to their homes, and ensuring follow-up.