Prevalence and Determinants of Hypertension in India Based on the 2017 ACC/AHA Guideline: Evidence from the India National Family Health Survey

OBJECTIVE: To estimate the prevalence and determinants of hypertension in India based on a new definition by the 2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults, and compare prevalence estimates with those of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). METHODS: We used the National Family Health Survey (NFHS-4) conducted in India (n = 212,007). We accounted for the sampling strategy by applying survey weights. RESULTS: Prevalence of hypertension among Indians aged 15-49 years was 40.6% (95% confidence interval [CI]: 40.3-41.0) and 13.0% (95% CI: 12.8-13.2) based on 2017 ACC/AHA and JNC7 guidelines respectively. The overall absolute increase in prevalence was 27.6% (95% CI:27.3-27.9). The absolute changes in crude prevalence of hypertension between the JNC7 and 2017 ACC/AHA guidelines for men and women were 31.4% (95% CI: 30.9-31.9) and 23.7% (95% CI: 23.5-23.9), respectively. As per both guidelines, the overall prevalence was significantly higher among older people, age, male sex, overweight/obesity, higher wealth status, and urban residence. CONCLUSION: Applying the 2017 ACC/AHA guideline to the Indian population led to a significant increase in the proportion of Indians with hypertension. There is also socioeconomic differences in the prevalence of hypertension as per both guidelines. Implementation and expansion of public health efforts for prevention and control strategies for hypertension is warranted.