Key result
~72% of known hypertensives in India remain untreated amid severe awareness and control gaps.
Why the study?
The rule of halves is commonly used to describe gaps in hypertension management, but its validity across different states and sociodemographic factors in India was not assessed nationally.
Cross-Sectional (n=770,662)
Yes
In India, while hypertension detection and control among treated individuals show progress, a major gap remains with 72% of known hypertensives not receiving treatment.
Substantial gaps in hypertension awareness and treatment persist in India; leaves open effective strategies to improve detection and control.
Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey-4 was conducted. We included 770,662 individuals (112,122 men and 658,540 nonpregnant women) of 15-49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%-49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%-72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%-40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three-fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.
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Goel et al. (2022) conducted a cross-sectional in Hypertension (n=770,662). Hypertension care cascade was evaluated on Proportion of individuals not aware of hypertension status, known hypertensives not availing treatment, and uncontrolled BP among those on treatment. Among individuals with high blood pressure in India, 48.5% were unaware of their status, 72% of known hypertensives were untreated, and 39.8% of those on treatment had uncontrolled blood pressure.
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