Key result
Male sex linked to ~32% higher prevalence of undiagnosed hypertension versus women in South India.
Why the study?
The applicability of the rule of halves in hypertension prevalence and management in an urban population of Puducherry, South India, was assessed to identify correlates of undiagnosed hypertension for targeted screening.
Cross-Sectional (n=2,399)
No
In an urban South Indian population, the rule of halves remains relevant, with 54% of hypertensive individuals being undiagnosed, highlighting the need for targeted screening in vulnerable subgroups.
Undiagnosed hypertension disproportionately affects urban South Indian men; hypothesis-generating for targeted screening programs pending prospective studies.
BACKGROUND: The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening. METHODOLOGY: We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014-15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg. RESULTS: Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%-35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%-16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension. CONCLUSION: In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.
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Kar et al. (2017) conducted a cross-sectional in Hypertension (n=2,399). Male sex vs. Female sex was evaluated on Undiagnosed hypertension (p=< 0.001). In an urban South Indian population, 33.3% of adults had hypertension, with undiagnosed hypertension being significantly more common in men than women (26.1% vs. 19.8%, P<0.001).
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