Key result
Public hospital care linked to ~96% higher odds of hypertension control versus private hospitals.
Why the study?
The study was conducted to identify provider- and institution-level factors associated with achieving guideline-recommended control of hypertension and diabetes mellitus in primary and secondary healthcare institutions in Kerala, India.
What is the rate of guideline-recommended control of hypertension and diabetes in Kerala, India, and what factors are associated with it?
Cross-Sectional (n=4,679)
Yes
What is the rate of guideline-recommended control of hypertension and diabetes in Kerala, India, and what factors are associated with it?
Effect estimate: AOR 1.96 (95% CI 1.50-2.57)
Absolute Event Rate: 36.48% vs 23.6%
A majority of hypertensive patients in Kerala, India, do not have controlled blood pressure, especially with coexisting diabetes, highlighting the need for improved prescription rationality and treatment intensification.
Hypertension control remains low in Kerala with public hospital advantage; cross-sectional data leaves open causal factors and generalizability.
OBJECTIVE: We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. METHODS: This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. RESULTS: Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50-2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. CONCLUSIONS: In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
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Sreelal et al. (2022) conducted a cross-sectional in Hypertension and Diabetes Mellitus (n=4,679). Public hospital care vs. Private hospital care was evaluated on Hypertension control (BP < 140/90 mm Hg) in hypertension-only patients (AOR 1.96, 95% CI 1.50-2.57). In a cross-sectional study in Kerala, India, hypertension control was achieved in only 31.5% of patients with hypertension alone, with public hospitals showing higher odds of control compared to private hospitals (AOR 1.96).
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