What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=1542). Intervention: 8-year follow-up vs. Baseline. Primary outcome: Hypertension prevalence (p=0.002).

What does this research mean for the field?

Over an 8-year follow-up in a rural North Indian cohort, hypertension prevalence significantly increased from 34.4% to 40.4%, alongside improvements in awareness and treatment but persistently poor disease control. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 19, 2023Open Access

Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India

Key Result

Over an 8-year follow-up in a rural North Indian cohort, hypertension prevalence significantly increased from 34.4% to 40.4%.

Study Design

Type

Cohort (n=1,542)

Structured PICO

Population

1,542 adults ≥ 30 years from a rural community cohort in Haryana, North India (Palwal district)

Outcome

Trends in hypertension prevalence, awareness, treatment, and control over 8 yearssurrogate

In a rural North Indian cohort, hypertension prevalence and incidence are high and increasing over 8 years, and despite improvements in awareness and treatment, blood pressure control remains poor.

Main Result

Absolute Event Rate: 40.4% vs 34.4%

p-value: p=0.002

Limitations

High attrition rate largely influenced by the COVID-19 pandemic
Restricted to a single Mendelian community, which may limit generalizability to the national level
Use of different instruments for blood pressure measurement at baseline (mercury sphygmomanometer) and endline (automated monitor)

Abstract

Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.

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