Did you know that almost one-fifth of Indians have hypertension? And that women have better control over their hypertension as compared to men? Or that hypertension is a major risk factor for cardiovascular disease – the leading cause of death in India.
Why is something that affects so many of us rarely discussed or even known about?
A new study conducted by PLOS Medicine aims to fill the information gap with evidence on hypertension cases and care in India. Only when we have the stats can we move on to devise specific interventions through treatments and policy changes, and monitor any tangible progress.
The study focuses on finding the “proportion of adults with hypertension who have been screened, are aware of their diagnosis, take anti-hypertensive treatment, and have achieved control” and the difference within states and union territories.
Hypertension care medicines are inexpensive and effective, but “only a minority of adults with hypertension are diagnosed and receive treatment.”
When we look at the rise of cardiovascular diseases (CVD) in India, this lack of attention to hypertension is shocking and deserving of more detailed attention.
A Problem of Awareness
The study says that out of their “nationally representative sample of 731,864 adults aged 15-49 years in India,” there was a high proportion of people with hypertension who had even had their BP measured (76 percent) but “less than half (45 percent) of individuals with the condition were aware of their diagnosis.”
The following diagram shows the percentage of people in various versions of the “care cascade” or where in the entire process of care (awareness, treatment and care) they fall in.
As the study says, “the highest absolute losses to care occurred at the awareness (31.4 percentage points) and treatment (31.4 percentage points) stages, and the highest relative loss at the treatment stage (70.3 percent),” and so the interventions need to be focused on these two aspects.
Speaking to FIT, Dr Subhojit Dey, executive director, Disha foundation, said that the findings “emphasise the maximum need for increased awareness, and access to right doctors and medications.”
States differ considerably in how they care for hypertension with Kerala and Jammu and Kashmir doing well while Chhattisgarh and Nagaland doing worse. Puducherry, Tamil Nadu, Sikkim and Haryana have maximum percentage of populations with uncontrolled hypertension.Dr Subhojit Dey
The study says that Jammu and Kashmir and Kerala are “role model” states, and Dr Dey tells us that is an indicator of the success of their specific state-level healthcare systems.
Because of the discrepancy in state size, the study mentions that “large states with relatively low hypertension prevalence may still host a high absolute number of adults with uncontrolled hypertension.”
For example, Uttar Pradesh had “one of the lowest prevalence levels for hypertension in the observed age group had the highest estimated absolute number of adults with uncontrolled hypertension.”
They also warned that Tamil Nadu was a priorty state, as it had “both the second highest proportion of adults aged 15 to 49 years with uncontrolled hypertension (28.8 percent) and the second highest absolute number of adults in that age range with uncontrolled hypertension.”
Talking on the urban-rural divide, the results were as one would have expected – urban populations generally perform better in healthcare due to better, easier access and resources.
Urban populations do better than rural in all fronts – checkup, awareness, treatment and control.Dr Subhojit Dey
Gender and Healthcare: Are the Results Saying Women Treat Hypertension Better?
Yes and no it seems, but it’s clear that further analysis is required.
A limitation of the study said that they sampled substantially fewer men than women, but “the absolute number of men sampled was still sufficient to obtain reasonably precise estimates of hypertension care cascade indicators among men,” reads the study.
Additionally, their methods included adjusting the sample size to the sex distribution of India’s population so that despite the oversampling of women, the results were representative.
Dey added that the age bracket may have something to do with the skewed gendered aspect of the study.
The sample size in this study is from the age-group of 15-49 years. Since hypertension is more prevalent above 50 years, younger men might ignore, overlook or neglect diagnoses of hypertension. This might be another reason behind lower hypertension control among men in this study.Dr Subhojit Dey
The Way Ahead
This study aims to be a starting point for further healthcare progress in hypertension cases. By collating state-wise data, there is now a precise road map to the way ahead.
Given the burden of disease due to hypertension, there must be concerted campaigns by state governments to increase awareness on hypertension. Opportunistic screening of people at health centres, and by ANMs & ASHAs at primary level must be increased.Dr Subhojit Dey
Dey adds that since blood pressure testing has become easier with enhancements in technology, there is an increased chance of ‘opportunistic testing’.
There is a need for healthcare providers to step in and take note of these findings.
“Access to hypertension management protocols and medicines must be increased in both public and private health sectors, with increased involvement of primary care physicians, AYUSH doctors, informal providers so that hypertension management becomes as common as hypertension,” says Dr Subhojit Dey.