Hypertension diagnosis, treatment, and control in India: nationally representative results from 1.69 million adults, 2019-2021

Background Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum in India –including diagnosis, treatment, and control– did not assess district level variation. Local data are critical for planning, implementation, and monitoring efforts to curb hypertension burdens. Our objective is to characterize the hypertension care continuum in India among individuals aged 18-98 years old at national, state, and district levels and by socio-demographic group. Methods Data were from 1,895,297 individuals in the nationally representative Fifth National Family Health Survey (NFHS-5), 2019-21. Hypertension was defined as self-reported diagnosis or newly measured blood pressure ≥140/90 mmHg. Among those with hypertension, we calculated the proportion diagnosed (self-reported). Among those with diagnosed hypertension, we computed the proportion treated (self-reported medication use). Among those treated, we calculated the proportion controlled (BP <140/90 mmHg [20-80 years] or <150/90 mmHg [>80 years]) based on national guidelines. Estimates were also provided among the total with hypertension. To assess differences in the care continuum between or within states (i.e. between districts), we partitioned the variance at both levels using linear mixed models. Results Among 1,691,109 adult respondents nationally (52.6% female; mean age: 41.6 years), 28.2% [95%CI: 28.0-28.4] had hypertension, of whom, 36.7% [36.3-37.2] were diagnosed. Among those diagnosed, 44.7% [44.1-45.3] reported taking medication (17.7% [17.5-17.9] of total with hypertension). Among those treated, 52.3% [51.4-53.1] had blood pressure control (9.1% [8.9-9.2] of total with hypertension). There were substantial variations across districts in diagnosis [range: 6.3–77.5%], treatment [8.7–97.1%] and control [2.7–76.6%]. Notably, large proportions of the variation in hypertension diagnosis (53.7%), treatment (32.8%), and control (57.7%) were within states, not just between states. Conclusions In India, more than 1 in 4 people have hypertension, and of these, only 1 in 3 are diagnosed, less than 1 in 5 are treated, and only 1 in 11 controlled. National averages hide considerable state- and district-level variation in the care continuum, implying the need for targeted, decentralized solutions to improve the hypertension care continuum in India.