Prevalence of hypertension in India: A meta-analysis

Managing high disease burden: a study of medication rationality in diabetes and hypertension in Andhra Pradesh

Objectives

To assess the burden of chronic Non-communicable diseases (NCDs) such as diabetes and hypertension, and evaluate the utilization of drugs for their treatment among the population of Andhra Pradesh, India.

Methods

A cross-sectional study was conducted to analyse the prevalence of diabetes and hypertension, as well as the pattern of drug usage for their management. Data were collected through surveys and medical records review.

Results

The study revealed a high prevalence of diabetes and hypertension in Andhra Pradesh, with significant proportions of the population remaining untreated despite critical drug utilization. Commonly used antidiabetic drugs included metformin, glipizide, and insulin, while telmisartan, furosemide, and metoprolol were frequently utilized for hypertension treatment. Side effects associated with these drugs were reported, emphasizing the need for better public awareness campaigns, improved access to healthcare, and effective management of side effects.

Conclusions

The findings underscore the importance of early detection and preventive measures for hypertension and diabetes. There is a pressing need for tailored interventions addressing social and economic factors contributing to non-adherence to treatment regimens. While the widespread use of medications indicates significant awareness and proactive healthcare among a substantial portion of the population, the presence of individuals not adhering to their treatment suggests significant gaps in awareness and access to healthcare services. This study provides crucial insights into medication patterns for managing diabetes and hypertension in Andhra Pradesh, laying the groundwork for targeted public health interventions.

Prevalence of Hypertension Among the Rural Adult Population in India: A Systematic Review and Meta-Analysis

Hypertension is a major cause of premature death worldwide. Studies have shown that the rural adult population in India is also experiencing this burden. To determine the overall pooled prevalence of primary hypertension in the adult rural population of India, an extensive search was conducted in various databases such as MEDLINE/PubMed, IndMED, EBSCO, CINAHL, and Google Scholar from 01/01/2014 to 16/05/2024. The studies were reviewed by two authors independently, assessing their quality and extracted data using pre-coded spreadsheets. The pooled estimates of hypertension prevalence were calculated using the Der Simonian-Laird random effects model, and subgroup, sensitivity analyses, and meta-regression were performed. In the final review, a total of 10 studies involving 30757 subjects were included. The combined pooled estimate of hypertension prevalence was 24% (95% CI: 19, 29) and there was a significant level of heterogeneity observed among the studies (I2=98%, Q=572.07, df=9, p<0.01). Subgroup analyses found that factors such as the year of study, region, type of BP apparatus used, sampling strategy, and BP measurement techniques had a significant impact on the prevalence of hypertension. Further analysis by meta-regression revealed that none of these covariates had a substantial influence on the prevalence (R2=0.21, Q=572.07, df=9, p-value<0.01). The prevalence of hypertension in adult rural populations exhibited a consistent upward trend over a period of 10 years from 2014 to 2024. Concerned policymakers should focus on the changing health needs of the rural adult population of India.

Age variation in blood pressure: Rural-urban and sex differences among the Hmar adults of Manipur, Northeast India

BACKGROUND

Increase in blood pressure (BP) is thought to be an unavoidable consequence of ageing but in secluded communities and in rural areas this is not the case.

AIMS

The present study aims to examine blood pressure response with age across place of residence and sex; the prevalence of hypertension in relation to place of residence and sex; and to find out the relative importance of biological and behavioural factors as risk factors for hypertension among the Hmar adults (17 to 70 years of age) of Manipur, Northeast India.

MATERIALS AND METHODS

A cross-sectional sample was collected on 1207 Hmars adults residing in rural and urban settings in Manipur, Northeast India. Demographic data, blood pressure, height, weight and behavioural factors were collected.

RESULTS

Blood pressure significantly increases with an increasing age and this trend is more pronounced in urban settings compared to rural settings. The overall prevalence of hypertension in the present study is about 21 per cent. Urban Hmar males, rural and urban Hmar females who are ≥ 45 years of age show significantly higher risk of developing hypertension compared to their counterparts who are < 45 years of age, but the same is not observed in Hmar males from rural areas. Males show significantly higher odds of developing hypertension compared to females in both the settings. Obesity is the strongest predictor of hypertension in both the place of residence and sexes.

DISCUSSION AND CONCLUSION

The present study confirms that population blood pressure does not show a marked increase with increasing age in traditional/rural areas which is clearly perceptible in Hmar men. It also strengthen the case that urban residence, men, increasing age and overweight and/or obese significantly increases the odds of developing hypertension.

Correlation Between Ambulatory Blood Pressure Monitoring and Office Blood Pressure Measurement in Patients with Hypertension: A Community Study

Background The current gold standard for blood pressure (BP) measurements is based on office BP measurements (OBPMs) by a sphygmomanometer or a digital device. Ambulatory BP measurement (ABPM) is a noninvasive method for continuous monitoring of BP over a period during routine activities of the patient. Thus, ABPM offers multiple BP readings during the patients' daily routine as compared to the single reading by OBPM at rest. A good correlation exists between mean 24-hour BP readings and the prediction of cardiovascular events. The present multicenter observational study was aimed to assess the correlation between ABPM and OBPM in patients with newly diagnosed, controlled, or uncontrolled hypertension in the community setting. Our hypothesis was to test if ABPM provides any further value in those hypertensive patients in whom the office blood pressure levels are controlled. A supplementary hypothesis was whether obtaining ABPM in patients with newly diagnosed or uncontrolled hypertension yields any value over and beyond OBPM. Another objective was to find out the applicability of ABPM in the community setting where the medical care is provided by primary care family physicians and not by specialists. Materials and Methods A total of 1000 patients were analysed for this study. Those with controlled hypertension were assigned to Group A, and those with newly diagnosed/untreated hypertension comprised Group B. Group A was followed up during Visit 2 and Group B was followed up during Visit 2 and either Visit 3 or Visit 4 to assess the BP measurements by ABPM and OBPM. Results The correlation between ABPM and OBPM showed minimal variation in the BP readings of Group A subjects at Visit 2. A variation in BP readings was observed in Group B at Visit 2. Furthermore, the correlation was established between ABPM and OBPM noted for Group B subjects during Visit 3, and minimal variation was noted during Visit 4. Conclusions A good correlation was observed between ABPM and OBPM during both visits in patients in Groups A and B. However, a notable variation was noted in the diastolic BP readings. Thus, large-scale clinical studies are required to detect the prevalence of hypertension, masked hypertension, and dipping patterns associated with hypertension and other related medical co-morbidities.

Hypertension is an important risk determinant for chronic kidney disease: results from a cross-sectional, observational study from a rural population in South India

Hypertension (HTN) is an important cause for chronic kidney disease (CKD). There is a paucity of studies exploring the association of HTN with CKD from rural India. The objective of the study was to determine the prevalence and the determinants for HTN in a rural population in South India, focusing on the association with CKD. In a cross-sectional study on 2984 adults in three villages, demographic and anthropometric data were collected. Blood pressure was recorded on all individuals and prevalence was estimated. Proteinuria, microalbuminuria (MA) and estimated glomerular filtration rate (eGFR) were determined in a subgroup of 1331 subjects and the relation with HTN was analysed. Prevalence of HTN was 30.4% (95% CI 28.75-32.05%). In all, 78.08% had stage 1 HTN while 22% had stage 2 HTN. In total, 27.4% (249/908) subjects were aware of their hypertensive status. Of them, only 14.4% had adequate control of blood pressure. Age>50 years, diabetes, body mass index >25 and eGFR<60 ml min^-1 were independent significant predictors of HTN (P<0.05). HTN was found to be an important risk factor for CKD even after adjusting for age, diabetes and cardiovascular risk factors (OR 2.22, 95% CI 1.46-3.36, P<0.001). The high prevalence of HTN, very low level of awareness and control, and the significant association with kidney disease indicate a need for stronger public health initiative with better penetration for awareness and screening for HTN and CKD in India's villages.

Effect of Aerobic Exercise Training on Blood Pressure in Indians: Systematic Review

Introduction. High blood pressure (BP) is one of the most important modifiable risk factors for cardiovascular diseases, which accounts for one in every eight deaths worldwide. It has been predicted that, by 2020, there would be 111% increase in cardiovascular deaths in India. Aerobic exercise in the form of brisk walking, jogging, running, and cycling would result in reduction in BP. Many meta-analytical studies from western world confirm this. However, there is no such review from Indian subcontinent. Objective. Our objective is to systematically review and report the articles from India in aerobic exercise on blood pressure. Methodology. Study was done in March 2016 in Google Scholar using search terms “Aerobic exercise” AND “Training” AND “Blood pressure” AND “India.” This search produced 3210 titles. Results. 24 articles were identified for this review based on inclusion and exclusion criteria. Total of 1107 subjects participated with median of 25 subjects. Studies vary in duration from +3 weeks to 12 months with each session lasting 15–60 minutes and frequency varies from 3 to 8 times/week. The results suggest that there was mean reduction of −05.00 mmHg in SBP and −03.09 mmHg in DBP after aerobic training. Conclusion. Aerobic training reduces the blood pressure in Indians.

Correlation between hypertension and hyperglycemia among young adults in India

AIM

To assess the correlation between blood pressure levels and fasting plasma glucose levels among young adults attending Chatrapati Shahuji Maharaj University, Kanpur, India.

METHODS

The present study was cross-sectional in nature, conducted among students in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. Study subjects included 185 young adults. Among them, 94 were males and 91 were females, in the age group 17 to 19 years.

RESULTS

Mean age among males was 18.5 ± 1.5 years and among females was 17.9 ± 1.8 years. Of the total 185 study subjects, 61 (32.9%) were classified as pre-diabetic and 20 (10.8%) as pre-hypertensive. Mean waist circumference, systolic blood pressure and serum high density lipoprotein did not vary significantly between normoglycemic and pre-diabetic subjects. However, the mean diastolic blood pressure of pre-diabetics (82 ± 5 mmHg) was significantly higher than normoglycemics (79 ± 6 mmHg). Mean serum cholesterol, serum triglycerides, serum low density lipoprotein (LDL) and serum very low density lipoprotein was also higher among pre-diabetic subjects in comparison to normoglycemic subjects and the difference was statistically significant. Upon multiple linear regression analysis, it was observed that body mass index (BMI) (β = 0.149), diastolic blood pressure (β = 0.375) and serum LDL (β = 0.483) were significantly associated with fasting plasma glucose. Multiple linear regression with diastolic blood pressure as the outcome variable showed that BMI (β = 0.219), fasting blood glucose (β = 0.247) and systolic blood pressure (β = 0.510) were significantly associated.

CONCLUSION

A significant prevalence of pre-diabetes and pre-hypertension in young adults is a matter of concern therefore all young adults need to be targeted for screening of diabetes and hypertension and lifestyle modification.

Cut-off of body mass index and waist circumference to predict hypertension in Indian adults

AIM: To determine the cut-off values of body mass index (BMI) and waist circumference to predict hypertension in adults in north India.

METHODS: A community based cross-sectional study was conducted in 801 subjects in Kanpur, aged 20 years and above, using multistage stratified random sampling technique. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of BMI and waist circumference to predict hypertension.

RESULTS: The ROC analysis revealed that BMI is a good predictor of hypertension for both men (area under the ROC curve 0.714) and women (area under the ROC curve 0.821). The cut-off values of BMI for predicting hypertension were identified as ≥ 24.5 kg/m² in men and ≥ 24.9 kg/m² in women. Similarly, the ROC analysis for waist circumference showed that it is a good predictor of hypertension both for men (area under the ROC curve 0.784) and women (area under the ROC curve 0.815). The cut-offs for waist circumference for predicting hypertension were estimated as ≥ 83 cm for men and ≥ 78 cm for women. Adults with high BMI or high waist circumference had a higher prevalence of hypertension, respectively.

CONCLUSION: Simple anthropometric measurements such as BMI and waist circumference can be used for screening people at increased risk of hypertension in order to refer them for more careful and early diagnostic evaluation. Policies and programs are required for primary and secondary prevention of hypertension.