The prevalence of concurrently raised blood glucose and blood pressure in India

The growing burden of diabetes and hypertension was predicted 15 years ago both globally and for specific countries, including India. In 2004, Wild et al. [1] projected that prevalent diabetes mellitus in India would rise from 31.7 million adults in 2000 to 79.4 million by 2030. Similarly, Kearney et al. [2] projected that prevalent hypertension would grow from 118.2 to 213.5 million adults between the years 2000 and 2025. In their study, Bischops et al.[3] quantified the prevalence of raised blood pressure (BP, mmHg) and raised blood glucose and their co-occurrence from three large household surveys conducted across India between 2012 and 2016. The authors focused on raised BP and glucose, which were measured during the household surveys rather than prevalent hypertension and diabetes, as most participants were not asked whether they had these conditions. The principal purpose of the analysis was to help inform resources required for integrated, personalized management of cardiovascular risk factors and related diseases given the somewhat fragmented state of current care. Moreover, cardiovascular disease accounted for 14.1% of disability-adjusted life years in India during 2016, an approximate doubling from 6.9% in 1990, which highlights the health and economic need for effective, integrated management of cardiovascular risk factors and diseases. Among more than 2 000 000 individuals with values for both BP and blood glucose in the three household surveys across India, 22.1% had BP values of 140 or higher systolic and/or 90 or higher diastolic. A total of 6.4% fasting glucose at least 126 mg/dl or nonfasting glucose ≥200 mg/dl, and 1.5% had elevated values for both BP and glucose, which could be interpreted as uncontrolled hypertension and diabetes. The authors also reported that concurrently uncontrolled hypertension and diabetes increased with age, BMI and household wealth quintile and was more common in urban than rural communities. For example, concurrently elevated BP and glucose increased from less than 1% at age 25–34 years to nearly 8% at ages 55–64 years. Similarly, the percentage of individuals with elevated values for both risk factors rose from nearly 1 to 6% as BMI increased from 20.0–22.9 to at least 30 kg/m2. At any BMI, concurrently uncontrolled hypertension and diabetes was more prevalent in urban than rural settings and positively and significantly related to household wealth [3]. Although not specifically addressed, the factors associated with concurrently elevated BP and glucose values predict a rapid increase in comorbid hypertension and diabetes over the next three to four decades. For example, among adults at least 50 years, concurrent elevation of BP and glucose was present in 4.5% with BMI less than 23 kg/m2 to 16.1% of those with BMI at least 30 kg/m2[3]. The population at least 50 years of age is expected to more than double [4,5], while percentages of individuals living in urban locations will nearly double [6]. The percentage of overweight and obese increased from approximately 39% of adults in 2014 to 49% in 2023 [7]. Thus, the projection for overweight and obesity to reach 60% in 2050 assumes significant slowing in rate of increase expected between 2014 and 2023. Looking forward to 2050, the economy of India is projected to grow much faster than that of China and the U.S., as India's share of global domestic product is estimated to grow from 2.8% in 2016 to 15% in 2050 [8]. Although it is unknown how the tremendous projected growth in in GDP will translate to the population of India, household wealth will likely increase, especially for the urban population [6]. The projected changes in India's population, population age profile, urbanization, income and excess weight support the large increases in prevalent diabetes and hypertension projected in 2004 and 2005, respectively [1,2]. In fact, the estimates may prove conservative. Dr. Bischops et al. [3] provided data that assist in projecting the future burden of concurrently uncontrolled hypertension and diabetes and in estimating the healthcare system resources required to provide effective, integrated management of multiple cardiovascular risk factors and related diseases. Their findings will also hopefully stimulate thoughtful discussion on efficient strategies, tactics and resource allocation required to significantly reduce the projected burden of diabetes, hypertension and other noncommunicable diseases that typically follow access to excess calories, including refined sugar and fat, salt, labour saving devices and passive (sedentary) entertainment. India serves as a large proxy for health changes in countries with currently low and middle incomes regarding the rapidly escalating health and economic burden of noncommunicable diseases. On the basis of projected economic growth, India may have the financial resources required to proactively address the projected epidemic of cardiovascular risk and disease and to share lessons learned with other countries facing comparable challenges (Table 1).TABLE 1: Projected changes in India's total population, age more than 50 years, urban population, obesity and gross domestic projectACKNOWLEDGEMENTS Conflicts of interest There are no conflicts of interest.