Key result
Age ≥60 years linked to ~9-fold greater odds of hypertension in an urban Delhi slum.
Why the study?
There is a paucity of information on the care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India.
Cross-Sectional (n=8,850)
No
Odds Ratio: 9.15 (95% CI 7.82–10.7)
Absolute Event Rate: 62.34% vs 14.81%
p-value: p=<0.001
There is a high burden of undiagnosed hypertension, low medication adherence, and poor blood pressure control in urban slum settings in India, highlighting significant gaps in the primary care cascade.
High undiagnosed hypertension in Delhi slums signals primary care gaps; leaves open scalable interventions to close the care cascade.
BACKGROUND: Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. METHODS: This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. RESULTS: We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). CONCLUSIONS: Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.
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Singh et al. (2023) conducted a cross-sectional in Hypertension (n=8,850). Age ≥ 60 years vs. Age 18-39 years was evaluated on Presence of hypertension (AOR 9.15, 95% CI 7.82-10.70, p=<0.001). In an urban slum in Delhi, 28.6% of adults had hypertension, with age ≥ 60 years strongly associated with increased odds of the condition (AOR 9.15) alongside high rates of undiagnosed cases.
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