Emerging trends in hypertension epidemiology in India

Health disparity at the intersection of religion and caste: Evidence from India

Objective

The provisions and recognition of Schedule Castes (SCs), the constitutional term for the Dalits in India, have been exclusively extended to Hindus, Buddhists, and Sikhs (HBS). Omission of Dalit Muslims and Christians (MC) from the SC category stripped them of the affirmative action benefits tied with the SC status. This study aimed to explore how such differential treatment might play a role in differential health outcomes in Dalit women in India.

Methods

Drawing data on 177,346 Dalit women, aged 20 to 49 years, from two successive nationally representative surveys, we assessed the differential likelihood of hypertension and diabetes, between MC- and HBS- Dalit women. Accounting for birth cohort-, survey wave-, and state of residence- fixed effects, along with socioeconomic conditions and cardiometabolic risk factors, we obtained adjusted odds of having hypertension and diabetes in MC women. To check the validity of our results, we conducted similar analyses using data on 170,889 Scheduled Tribe (ST) women, another marginalized group, whose ST-status recognition were not tied to religion.

Results

We found that Dalit MC women were 1.13 (95% CI: 1.03-1.25) and 1.19 (95% CI: 1.05-1.36) times more likely to have hypertension and diabetes, respectively, compared to Dalit HBS women. Conversely, no statistically significant differential likelihood of these conditions was observed between MC and HBS women in the ST sample.

Conclusion

Our investigation thus, indicated a potential link at the crossroads of religion and caste that may contribute to the health disparities among marginalized women in India.

Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15-49 years in India: insights from the National Family Health Survey (NFHS-5)

OBJECTIVES

To estimate the prevalence and identify the factors associated with undiagnosed hypertension in India.

STUDY DESIGN

A secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019-2021.

METHODS

Information on hypertension among individuals aged 15-49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender.

RESULTS

The survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%-8.87%) and was higher among males [13.56% (13.03%-14.12%)] than in females [8.14% (8.03%-8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%-45.55%) and was higher in males [65.94% (64.25%-67.60%)] than in females [42.18% (41.66%-42.71%)].

CONCLUSIONS

Our findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.

Gender Differential Prevalence of Overweight and Obesity, Hypertension and Diabetes in South India: A Population-Based Cross-Sectional Study

Background

India is facing triple epidemic of Non communicable diseases (NCDs) including high body mass index (BMI), high blood pressure and high blood glucose, contributing to more than half of deaths of all mortality, however, information in different demographics is limited, especially, in India. The aim of the study is to compare the prevalence of overweight, obesity, hypertension, and diabetes, along with the occurrence of multi-morbidity, across gender-specific populations in rural, suburban, and urban regions of India.

Methods

This was a cross-sectional, population-based study including adults aged 20 and above in rural, suburban, and urban areas near Coimbatore, India. All participants were interviewed using a detailed questionnaire and had their anthropometric measurements, including height, weight, blood pressure, and blood samples collected. Gender specific and location specific prevalence of overweight, obesity, hypertension, diabetes, and multimorbidity were assessed.

Results

This study included 2976 individuals, of which 865 were from rural areas, 1030 from sub-urban areas, and 1081 from metropolitan areas. The mean systolic and diastolic blood pressure were higher in rural participants than in sub-urban and urban participants, despite the fact that the prevalence of hypertension was higher in sub-urban (47.1%) than in rural (36.4%) and urban (39.7%, p < 0.001). In sub-group analysis, sub-urban areas had a greater prevalence of hypertension in both men and women (53.5% and 41.7%, p < 0.001) than rural areas (41.9% and 31.3%, p = 0.001) or urban areas (45.9% and 35.5%, p < 0.001). Compared to rural (16.1%) and urban (23%), sub-urban areas had a greater prevalence of diabetes (25.8%, p < 0.001). Urban residents (47.5%) had higher rates of overweight and obesity than rural (31.4%) and sub-urban (34.1%, p < 0.001) residents. The association between diabetes and hypertension was present in the unadjusted model and persisted even after age and BMI adjustments. Though not in men, higher levels of education were associated to a higher prevalence of diabetes in women. Diabetes was associated to being overweight or obese in women, however this association was significantly reduced once BMI was taken into account. The overall multimorbidity was 3.8%, however, women had a higher overlapping prevalence (2.8%) compared to men (1%, p < 0.001).

Conclusions

Diabetes and hypertension were prevalent comorbidities across all demographics, with higher rates in suburban and urban areas. Women exhibited higher rates of multimorbidity than men, regardless of the demographic area.

Peptidomics-based identification of antihypertensive and antidiabetic peptides from sheep milk fermented using Limosilactobacillus fermentum KGL4 MTCC 25515 with anti-inflammatory activity: in silico, in vitro, and molecular docking studies

This study investigated the synthesis of bioactive peptides from sheep milk through fermentation with Limosilactobacillus fermentum KGL4 MTCC 25515 strain and assessed lipase inhibition, ACE inhibition, α-glucosidase inhibition, and α-amylase inhibition activities during the fermentation process. The study observed the highest activities, reaching 74.82%, 70.02%, 72.19%, and 67.08% (lipase inhibition, ACE inhibition, α-glucosidase inhibition, and α-amylase inhibition) after 48 h at 37°C, respectively. Growth optimization experiments revealed that a 2.5% inoculation rate after 48 h of fermentation time resulted in the highest proteolytic activity at 9.88 mg/mL. Additionally, fractions with less than 3 kDa of molecular weight exhibited superior ACE-inhibition and anti-diabetic activities compared to other fractions. Fermentation of sheep milk with KGL4 led to a significant reduction in the excessive production of NO, TNF-α, IL-6, and IL-1β produced in RAW 267.4 cells upon treatment with LPS. Peptides were purified utilizing SDS-PAGE and electrophoresis on 2D gels, identifying a maximum number of proteins bands ranging 10-70 kDa. Peptide sequences were cross-referenced with AHTPDB and BIOPEP databases, confirming potential antihypertensive and antidiabetic properties. Notably, the peptide (GPFPILV) exhibited the highest HPEPDOCK score against both α-amylase and ACE.

Prevalence and Associated Risk Factors of Hypertension Among Tribal Population Aged 15-49 in India: Evidence from National Family Health Survey, 2019-2021

BACKGROUND

Approximately 10% of non-communicable diseases (NCDs) can be attributed to hypertension. The prevalence of hypertension is steadily increasing among urban, rural, and tribal populations alike. There has been a growing incidence of hypertension within underprivileged groups; however, there is a scarcity of research focusing on the risks of hypertension within Indian tribes. The current study aimed to estimate the pooled prevalence of hypertension among tribes and the risk factors of hypertension.

METHODS

This study uses data from the fifth phase of the National Family Health Survey (NFHS-5) in India, covering 2,843,917 individuals in 636,699 households. A total of 69,176 individuals belonging to tribal communities aged between 15 and 49, encompassing both males and females, have been incorporated into our study. The study utilized bivariate and multivariable binary logistic regression analyses, which were conducted using the R statistical software.

RESULTS

Among 69,176 tribal populations between 15 and 49 years, the overall prevalence of hypertension was 12.54% (8676/69176; 95% CI, 12.29%, 12.79%). The prevalence of hypertension among males was 16.4% and 12.07% among females. Age, gender, education, marital status, smoking, and alcohol consumption were found to be the significant predictors of hypertension among tribes.

CONCLUSION

The rising prevalence and potential dangers of hypertension within Indian tribes highlight their epidemiological transition burdened by significant cardiometabolic health concerns, necessitating prompt and ongoing monitoring and surveillance.

Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organization's building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.

Diabetes, hypertension, and other cardiovascular disease risk factors among adults in an urban underprivileged community in Bangalore city, India

Aim

Diabetes and hypertension are major risk factors of cardiovascular disease, which is known to be the leading cause of global mortality in the world today. Studies have shown that the prevalence of these risk factors is on the rise, with the burden of diabetes alone increasing by 80% in the last two decades. Complications of diabetes and hypertension result in huge public health challenges for the country and catastrophic medical expenditures for families among the urban poor. Our study aims to estimate the prevalence of diabetes, hypertension, and other cardiovascular risk factors among adults in an urban underprivileged community of Bengaluru city.

Objectives and Methods

A cross-sectional study was conducted over a period of 6 months where 2245 individuals aged 30 or older were interviewed using a structured interviewer-administered questionnaire used to capture sociodemographic details that assessed modifiable risk factors for diabetes and hypertension. Inclusion criteria for diabetes were considered if the random blood sugar reading was ≥200 mg/dL, whereas a diagnosis of hypertension was taken into consideration if the systolic blood pressure reading was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg.

Results

Among the 2245 participants that took part in the study, 15.5% were diabetics and 17.2% were hypertensive. There was a strong association of diabetes among consumers of alcohol, with more than one-third having a high prevalence of the disease (odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.1-3.9). More than half the population were consumers of junk food; the prevalence of diabetes in this group was 1.35 times higher than that in their counterparts (OR: 1.35, 95% CI: 1.0-1.8). A significant association of diabetes was also seen among those identified with central obesity (OR: 1.83, 95% CI: 1.4-2.5). One-third of the population who consumed alcohol were found to be diagnosed with hypertension (OR: 3.08, 95% CI: 1.6-5.9), and one-fifth of individuals who were regular consumers of junk food had a higher prevalence of hypertension (OR: 1.41, 95% CI: 1.1-1.8). A higher prevalence of hypertension was also seen among individuals with central obesity or a body mass index (BMI) of >30 (OR: 1.59, 95% CI: 1.2-2.1; OR: 1.92, 95% CI: 1.4-2.6).

Conclusion

The findings from our study conducted in an urban underprivileged area of Bengaluru city shed light on the significant associations between diabetes and hypertension and various demographic and lifestyle factors. Specifically, male gender and lower educational status were found to have a significant association with diabetes, whereas being unmarried and having a high BMI status were strongly linked to hypertension. In addition, the study revealed that elderly individuals, alcohol consumers, junk food eaters, and those with central obesity demonstrated an increased risk for both diabetes and hypertension. By identifying these risk factors, targeted interventions can be developed to address the unique challenges faced by this vulnerable section of society. Strategies can be designed to raise awareness, encourage healthier lifestyle choices, and improve access to healthcare services to effectively prevent and manage diabetes and hypertension in this community.

Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India

BACKGROUND

Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions.

OBJECTIVE

This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India.

METHODS

A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension.

RESULTS

The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension.

CONCLUSION

This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.

Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data

Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.

Healthcare cost coverage inequality and its impact on hypertension and diabetes: A five-year follow-up study in a Malaysian rural community

Background and Aims

Inequality in health care access is a socioeconomic driver for non-communicable disease related risk factors. This study examined the inequality trend in healthcare cost coverage (HCC) compared to private health insurance (PHI) coverage, a subtype of HCC, over 5 years. The study will also determine the association between HCC (and PHI) and the status of hypertension and diabetes diagnosis.

Method

The rich-poor ratio, concentration curve and concentration index were derived to determine the level of inequality. Furthermore, logistic regression was done to determine the association between HCC and the status of hypertension and diabetes.

Results

The PHI group (rich-poor ratio: 1.4 [rich: 454, poor: 314] and 2.6 [rich: 375, poor: 142]; concentration index: 0.123 [95% confidence interval, CI: 0.093-0.153] and 0.144 [95% CI: 0.109-0.178] in 2013 and 2018, respectively) has relatively higher inequality compared with the HCC group (rich-poor ratio: 0.9 [rich: 307, poor: 337] and 1.1 [rich: 511, poor: 475]; concentration index: -0.027 [95% CI: -0.053 to -0.000] and -0.014 [95% CI: -0.033 to 0.006] in 2013 and 2018, receptively). Contrasting to the observation with the HCC group, PHI was associated with higher odds for hypertension (adjusted odds ratio [aOR] = 1.252, p = 0.01, 95% CI: 1.051-1.493) and diabetes (aOR = 1.287, p = 0.02, 95% CI: 1.041-1.590) in 2018.

Conclusion

Over 5 years, the inequality in PHI coverage remained higher compared with HCC, which suggests that the rich enjoyed private healthcare more. Furthermore, those with PHI were more likely to report known hypertension and diabetes in 2018. It is reasonable to assume that those with PHI are more likely to have earlier diagnoses compared to others and are more likely to be aware of their condition. Policymakers need to identify strategies that can narrow the existing gap in quality and type of service between the private and public health sectors.

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20-1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09-1.32] and 9 % [PR: 1.09; CI: 1.00-1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

Interactions between AT1R and GRKs: the determinants for activation of signaling pathways involved in blood pressure regulation

The success of Angiotensin II receptor blockers, specifically Angiotensin II type 1 receptor (AT1R) antagonists as antihypertensive drug emphasizes the involvement of AT1R in Essential hypertension. The structural insights and mutational studies of Ang II-AT1R have brought about the vision to design Ang II analogs that selectively activate the pathways with beneficial and cardioprotective effects such as cell survival and hinder the deleterious effects such as hypertrophy and cell death. AT1R belongs to G-protein coupled receptors and is regulated by G-protein coupled receptor kinases (GRKs) that either uncouples Gq protein for receptor desensitization or phosphorylate C-terminus to recruit β-arrestin for internalization of the receptor. The interaction of GRKs with ligand activated AT1R induces conformational changes and signal either Gq dependent or Gq independent pathways. These interactions might explain the complex regulatory mechanisms and offer promising ideas for hypertension therapeutics. This article reviews the functional role of AT1R, organization of GRK genes and regulation of AT1R by GRKs that play significant role in desensitization and internalization of the receptors.

Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021

There has been raging discussion and debate around the quality of COVID death data in South Asia. According to WHO, of the 5.5 million reported COVID-19 deaths from 2020-2021, 0.57 million (10%) were contributed by five low and middle income countries (LMIC) countries in the Global South: India, Pakistan, Bangladesh, Sri Lanka and Nepal. However, a number of excess death estimates show that the actual death toll from COVID-19 is significantly higher than the reported number of deaths. For example, the IHME and WHO both project around 14.9 million total deaths, of which 4.5-5.5 million were attributed to these five countries in 2020-2021. We focus our gaze on the COVID-19 performance of these five countries where 23.5% of the world population lives in 2020 and 2021, via a counterfactual lens and ask, to what extent the mortality of one LMIC would have been affected if it adopted the pandemic policies of another, similar country? We use a Bayesian semi-mechanistic model developed by Mishra et al. (2021) to compare both the reported and estimated total death tolls by permuting the time-varying reproduction number (Rt) across these countries over a similar time period. Our analysis shows that, in the first half of 2021, mortality in India in terms of reported deaths could have been reduced to 96 and 102 deaths per million compared to actual 170 reported deaths per million had it adopted the policies of Nepal and Pakistan respectively. In terms of total deaths, India could have averted 481 and 466 deaths per million had it adopted the policies of Bangladesh and Pakistan. On the other hand, India had a lower number of reported COVID-19 deaths per million (48 deaths per million) and a lower estimated total deaths per million (80 deaths per million) in the second half of 2021, and LMICs other than Pakistan would have lower reported mortality had they followed India's strategy. The gap between the reported and estimated total deaths highlights the varying level and extent of under-reporting of deaths across the subcontinent, and that model estimates are contingent on accuracy of the death data. Our analysis shows the importance of timely public health intervention and vaccines for lowering mortality and the need for better coverage infrastructure for the death registration system in LMICs.

The influence of demographic and lifestyle factors on blood donation delay among student population: a retrospective study

Objective

This study analysed blood donation deferral trends, reasons and demographic/lifestyle characteristics among students in Huzhou City. The aim was to understand the health status of students and reduce the deferral rate.

Methods

Data on blood donation deferral among students in Huzhou City from 2018 to 2022 were collected and analysed. Deferral trends and main reasons were investigated. Using demographic and lifestyle data from 2,619 cases in 2022, a risk prediction model for deferral was constructed.

Results

The deferral rate among students in Huzhou City from 2018 to 2022 was 12.60% (p = 0.000, 95%CI: 12.14-13.06%), showing a significant increasing trend. Temporary deferral was the main reason, with alanine aminotransferase (ALT), blood pressure (BP) and haemoglobin (Hb) as the main deferral factors. ALT had a deferral rate of 5.23% (4.92-5.53%), BP 3.30% (3.06-3.55%), and Hb 2.92% (2.68-3.15%). Demographic and lifestyle characteristics in 2022 showed no significant differences between education level, household registration and deferral rate (p > 0.05). However, age, sex, blood donation history, sleep quality, diet and mental state had variable effects on ALT, BP, and Hb deferrals (p < 0.05). Logistic regression showed that sex, blood donation history, sleep quality, diet and mental status were independent risk factors for ALT deferral (p < 0.05), with odds ratios (ORs) of 5.057, 2.735, 1.594, 3.679, and 1.957, respectively. Age, blood donation history, sleep quality and mental state were independent risk factors for BP deferral (p < 0.05), with ORs of 0.256, 3.658, 6.042, and 1.812, respectively. Gender, blood donation history and diet were independent risk factors for Hb deferral (p < 0.05), with ORs of 0.244, 0.542, and 3.103, respectively.

Conclusion

Students' health problems require attention. Effective health education should improve self-health management and pre-donation health behaviour to encourage regular blood donation.

Dietary intakes of hypertensive patients in rural India: Secondary outcomes of a randomised, double-blind, controlled trial

Background

Hypertension is highly prevalent in India; however, little is known about the dietary intakes of those living with hypertension, particularly in rural areas. The primary aim was to assess the dietary intakes of individuals living in rural India with self-reported history of hypertension. As secondary analyses, we explored the dietary impact of a salt substitute in this population group.

Materials and methods

This study used data from a large randomised controlled trial conducted in seven villages across rural India. Participants received either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride) to replace all home salt use. Dietary intake at baseline and end-of-trial was assessed using 24-h dietary recalls. A range of dietary outcomes were assessed including energy intake, macronutrient intake and overall diet quality according to the Alternate Healthy Eating Index (AHEI).

Results

A total of 454 participants were included in the analysis. At baseline, mean (SE) energy intakes in regular salt group and salt substitute group were similar at 5240 (110) kJ/day and 5120 (106) kJ/day, respectively. This was largely attributable to intakes of carbohydrates (74.4% of total energy intakes for regular salt group vs 75.4% for the salt substitute group) followed by total fat (15.8% vs 15.4%) and protein (10.4% vs 10.3%). Both groups also had similar AHEI scores at baseline, with mean (SE) total scores equating to 33.0 (0.4) (out of a total 90) for the regular salt group and 32.7 (0.4) for the salt substitute group. Both groups received lowest AHEI scores across the following components: vegetables, fruit and wholegrains. At baseline, the mean (SE) intakes of sodium across the regular salt and salt substitute groups were similar at 2349 (67) mg/day and 2396 (64) mg/day, respectively. In the salt substitute group, there was a significant reduction in total sodium intakes over time (-264 mg/day, 95% CI, -442 to -85), driven by the use of the salt substitute.

Conclusion

This study found individuals with hypertension living in rural India had poor dietary intakes, including low intakes of fruits, vegetables and wholegrains, and high intakes of sodium. Salt substitutes may be an effective strategy for reducing sodium intake in this population group.

Trend of risk factors for cardiovascular diseases among young and middle-aged indians: Insights from a nationally representative survey

Background

India, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states.

Methods

The present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same.

Results

A declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019-21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey.

Conclusion

The present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.

Hypertension Prevalence, Awareness, Treatment, Control and Risk Factors in Tribal Population of India: a Multi-Centric Cross-Sectional Study

The prevalence of hypertension is increasing in the tribal population of India. Lifestyle modifications, including dietary changes and acculturation, are the main reasons for the high prevalence of hypertension among the Indian indigenous (tribal) population. This paper reports hypertension prevalence, awareness, treatment, control and risk factors among tribes in five districts of different geographical zones of India. A cross-sectional study was conducted among the adult tribal population of 7590 from these states. Data related to blood pressure, anthropometry, demographic and behavioural variables were collected with prior consent from the participants. The prevalence of hypertension is 34.0% and 28.3% among men and women, respectively. Of the total hypertensives, 27.5% were aware of their hypertension status; of them, 83.9% were receiving treatment, and blood pressure was in control among 33.5% of patients who were receiving treatment. Age, alcohol intake, sedentary lifestyle, Particularly Vulnerable Tribal Groups status and body mass index are found to be significantly associated with the prevalence of hypertension. The prevalence of hypertension is high among these tribal populations, which could be due to modernization and acculturation. Awareness and treatment-seeking behaviour are poor. Hence, early screening, awareness campaigns for seeking treatment, and health promotion are immediately required. Comprehensive health promotion programs need to promote lifestyle modification and re-orientation of the primary health care system to improve availability and accessibility to hypertension screening and treatment.

Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal

Background

Lifestyle modifications and medication compliance are key strategies.

Objectives

To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension.

Materials and Methods

A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16.

Results

Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group.

Conclusion

The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.

Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India

Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.

Control status of hypertension in India: systematic review and meta-analysis

BACKGROUND AND AIMS

Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India.

METHODS AND RESULTS

We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P  ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas.

CONCLUSION

We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.

Prevalence, awareness, treatment, control and correlates of prevalence and control of hypertension among older adults in Kerala: A Mixed Methods Study

INTRODUCTION

We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control.

METHODS

A mixed-methods study employing a sequential exploratory design was conducted with a survey of 300 participants aged >=60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis.

RESULTS

Hypertension prevalence was 72.3% (95% CI= 67.1-77.2), 68.2% (CI=61.8-74.2) were aware, 65.4% (CI=59.0-71.6) were treated and 24% (CI=18.6-29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)]=2.34; CI=1.19-4.59), current alcohol use (AOR=2.28; CI=1.06-4.91) and self-reported diabetes (AOR=2.02; CI=1.15-3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR=2.72, CI =1.34-5.55), with education level up to high school (AOR = 2.58, CI = 1.11-6.00) and who were in the age group 60-70 years (AOR=2.14, CI= 1.09-4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management.

DISCUSSION

Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above.

Hypertension treatment capacity in India by increased workforce, greater task-sharing, and extended prescription period: a modelling study

Background

The worldwide control rate for hypertension is dismal. An inadequate number of physicians to treat patients with hypertension is one key obstacle. Innovative health system approaches such as delegation of basic tasks to non-physician health workers (task-sharing) might alleviate this problem. Massive scale up of population-wide hypertension management is especially important for low- and middle-income countries such as India.

Methods

Using constrained optimization models, we estimated the hypertension treatment capacity and salary costs of staff involved in hypertension care within the public health system of India and simulated the potential effects of (1) an increased workforce, (2) greater task-sharing among health workers, and (3) extended average prescription periods that reduce treatment visit frequency (e.g., quarterly instead of monthly).

Findings

Currently, only an estimated 8% (95% uncertainty interval 7%-10%) of ∼245 million adults with hypertension can be treated by physician-led services in the Indian public health system (assuming the current number of health workers, no greater task-sharing, and monthly visits for prescriptions). Without task-sharing and with continued monthly visits for prescriptions, the least costly workforce expansion to treat 70% of adults with hypertension would require ∼1.6 (1.0-2.5) million additional staff (all non-physicians), with ∼INR 200 billion (≈USD 2.7 billion) in additional annual salary costs. Implementing task-sharing among health workers (without increasing the overall time on hypertension care) or allowing a 3-month prescription period was estimated to allow the current workforce to treat ∼25% of patients. Joint implementation of task-sharing and a longer prescription period could treat ∼70% of patients with hypertension in India.

Interpretation

The combination of greater task-sharing and extended prescription periods could substantially increase the hypertension treatment capacity in India without any expansion of the current workforce in the public health system. By contrast, workforce expansion alone would require considerable, additional human and financial resources.

Funding

Resolve to Save Lives, an initiative of Vital Strategies, was funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners (funded with support from the Chan Zuckerberg Foundation).

Hypertension Control Cascade and Regional Performance in India: A Repeated Cross-Sectional Analysis (2015-2021)

Background The weak control cascade of hypertension from the time of screening till the attainment of optimal blood pressure (BP) control is a public health challenge, particularly in resource-limited settings. The study objectives were to (1) estimate the change in the rate of prevalence of hypertension, the yield of newly diagnosed cases, initiation of treatment, and attainment of BP control in the age group 15 to 49 years; (2) ascertain the magnitude and predictors of undiagnosed hypertension, lack of initiation of treatment, and poor control of those on antihypertensive therapy; and (3) estimate the regional variation and state-level performance of the hypertension control cascade in India. Methodology We analyzed demographic and health surveillance (DHS) data from India's National Family Health Survey Fifth Series (NFHS-5), 2019-2021, and NFHS-4 (2015-2016). The NFHS-5 sample comprised 695,707 women and 93,267 men in the age group of 15 to 49 years. Multiple logistic regressions were performed to find the associated predictors, and respective adjusted odds ratios (aORs) were reported. Results The prevalence of hypertension (cumulative previously diagnosed and new cases) among individuals aged 15 to 49 years was 22.8% (22.6%, 23.1%; n = 172,532), out of which 52.06% were newly diagnosed cases. In contrast, in NFHS-4, the prevalence of hypertension among individuals aged 15 to 49 years was 20.4% (20.2%, 20.6%; n = 153,384), of which 41.65% were newly diagnosed cases. In NFHS-5, 40.7% (39.8% and 41.6%) of the previously diagnosed cases were on BP-lowering medications compared to 32.6% (31.8%, 33.6%) in NFHS-4. Furthermore, in NFHS-5, controlled BP was observed in 73.7% (72.7% and 74.7%) of the patients on BP-lowering medication compared to 80.8% (80.0%, 81.6%) in NFHS-4. Females compared to males (aOR = 0·72 and 0·007), residents of rural areas (aOR = 0·82 and 0·004), and those belonging to the socially disadvantaged groups were not initiated on treatment despite awareness of their hypertension status indicative of poor treatment-seeking behavior. Furthermore, increasing age (aOR = 0·49, P < 0·001), higher body mass index (aOR = 0·51, P < 0·001), and greater waist-to-hip ratio (aOR = 0·78, P = 0·047) were associated with uncontrolled hypertension in patients on antihypertensive drug therapy. Conclusions Hypertension control cascade in India is largely ineffectual although screening yield and initiation of antihypertensive treatment have improved in NFHS-5 compared to NFHS-4. Identification of high-risk groups for opportunistic screening, implementing community-based screening, strengthening primary care, and sensitizing associated practitioners are urgently warranted.

Characteristics and outcomes of gallbladder cancer patients at the Tata Medical Center, Kolkata 2017-2019

BACKGROUND

The north and north-eastern regions of India have among the highest incidence of gallbladder cancer (GBC) in the world. We report the clinicopathological charateristics and outcome of GBC patients in India.

METHODS

Electronic medical records of patients diagnosed with GBC at Tata Medical Center, Kolkata between 2017 and 2019 were analyzed.

RESULTS

There were 698 cases of confirmed GBC with a median age of 58 (IQR: 50-65) years and female:male ratio of 1.96. At presentation, 91% (496/544) had stage III/IV disease and 30% (189/640) had incidental GBC. The 2-year overall survival (OS) was 100% (95% CI: 100-100); 61% (95% CI: 45-83); 30% (95% CI: 21-43); and 9% (95% CI: 6-13) for stages I-IV, respectively (p = <0.0001).   For all patients, the 2-year OS in patients who had a radical cholecystectomy followed by adjuvant therapy (N = 36) was 50% (95% CI: 39-64), compared to 29% (95% CI: 22-38) for those who had a simple cholecystectomy and/or chemotherapy (N = 265) and 9% (95% CI: 6-14) in patients who were palliated (N = 107) (p = <0.0001).

CONCLUSION

The combined surgical/chemotherapy approach for patients with stage II GBC showed the best outcomes. Early detection of GBC remains problematic with the majority of patients presenting with stage III-IV and who have a median survival of 9.1 months. Our data suggests that the tumor is chemoresponsive and multi-center collaborative clinical trials to identify alternative therapies are urgently required.

Is iron status associated with markers of non-communicable disease in adolescent Indian children?

BACKGROUND

High body iron status has been associated with non-communicable diseases (NCD) like diabetes (high fasting blood glucose, FBG), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but this has not been examined in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children.

METHODS

The association of NCD with Serum Ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, body mass index, C-Reactive Protein, haemoglobin and sex, in adolescent (10-19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents.

RESULTS

The odds ratio (OR) of high FBG, HTN and TC were 1.05 (95% CI: 1.01-1.08), 1.02 (95% CI: 1.001-1.03) and 1.04 (95% CI: 1.01-1.06) respectively for every 10 µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBG by 2-14% across states of India. Similar increments in HTN and TC can also be expected.

CONCLUSIONS

High SF is significantly associated with NCD in adolescents, dependent on wealth and co-existing prediabetes. This should be considered when enhancing iron intake in anaemia prevention programs, and the NCD relationship with body iron stores should be studied.

Investigating the factors that explain white matter hyperintensity load in older Indians

White matter hyperintensities are areas of hyperintense signal on MRI that typically represent cerebrovascular pathology. While focal white matter hyperintensities are common among older individuals, extensive white matter hyperintensities have been found to accelerate the progression of dementia. However, little is currently known about how various socioeconomic, health, lifestyle and environmental factors affect the severity of these lesions, particularly in low- and middle-income countries such as India. We investigated this question using cross-sectional MRI data (n = 126) from a pilot neuroimaging sub-study of an ongoing, nationally representative epidemiological study of late-life cognition in India. As a screening step, we estimated white matter hyperintensity load from fluid-attenuated inversion recovery MRI using a fully automated technique and tested for associations with each factor separately, controlling for age, sex and estimated total intracranial volume in each case. A combined model of white matter hyperintensity load included five factors which were significant after multiple comparisons correction: systolic blood pressure, body mass index, urbanicity status (urban versus rural living), daily chore hours and the frequency of store trips. This model explained an additional 27% of the variance in white matter hyperintensity load (54 versus 27% for the baseline model with only age, sex and estimated total intracranial volume). We accounted for the possibility of reverse causality by additionally controlling for concurrent markers of neurodegeneration and cognitive impairment, with no substantial change in our findings. Overall, our findings suggest that controlling high blood pressure and maintaining both a healthy body mass index and high levels of physical activity may reduce white matter hyperintensity load in older Indian adults, helping to prevent or delay dementia.

Estimated glomerular filtration rate trajectories in south Asians: Findings from the cardiometabolic risk reduction in south Asia study

Background

Few longitudinal data characterize kidney function decline among South Asians, one of the world's largest population groups. We aimed to identify estimated glomerular filtration rate (eGFR) trajectories in a population-based cohort from India and assess predictors of rapid kidney function decline.

Methods

We used 6-year longitudinal data from participants of a population-representative study from Delhi and Chennai, India who had at least two serum creatinine measures and baseline CKD-EPI eGFR> 60 ml/min/1.73m² (n=7779). We used latent class trajectory modeling to identify patterns of kidney function trajectory (CKD-EPI eGFR) over time. In models accounting for age, sex, education, and city, we tested the association between 15 hypothesized risk factors and rapid kidney function decline.

Findings

Baseline mean eGFR was 108 (SD 16); median eGFR was 110 [IQR: 99-119] ml/min/1.73m². Latent class trajectory modeling and functional characterization identified three distinct patterns of eGFR: class-1 (no decline; 58%) annual eGFR change 0.2 [0.1, 0.3]; class-2 (slow decline; 40%) annual eGFR change -0.2 [-0.4, -0.1], and class-3 (rapid decline; 2%) annual eGFR change -2.7 [-3.4, -2.0] ml/min/1.73m². Albuminuria (>30 mg/g) was associated with rapid eGFR decline (OR for class-3 vs class-1: 5.1 [95% CI: 3.2; 7.9]; class-3 vs. class-2: 4.3 [95% CI:2.7; 6.6]). Other risk factors including self-reported diabetes, cardiovascular disease, peripheral arterial disease, and metabolic biomarkers such as HbA1c and systolic blood pressure were associated with rapid eGFR decline phenotype but potential 'non-traditional' risk factors such as manual labor or household water sources were not.

Interpretation

Although mean and median eGFRs in our population-based cohort were higher than those reported in European cohorts, we found that a sizeable number of adults residing in urban India are experiencing rapid kidney function decline. Early and aggressive risk modification among persons with albuminuria could improve kidney health among South Asians.

Funding

The CARRS study has been funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, under Contract No. HHSN2682009900026C and P01HL154996. Dr. Anand was supported by NIDDK K23DK101826 and R01DK127138.

RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus

Hypertension and diabetes mellitus (DM) are two of the leading lifestyle diseases in the Indian and South Asian populations that often co-exist due to overlapping pathophysiological factors. Obesity, insulin resistance, inflammation, and oxidative stress are thought to be some common pathways. Up to 50% of hypertensive cases in India are diagnosed with type 2 diabetes mellitus (T2DM), which defines the need for a comprehensive guideline for managing hypertension in diabetic patients. These RSSDI guidelines have been formulated based on consultation with expert endocrinologists in India and Southeast Asia, acknowledging the needs of the Indian population. Ambulatory blood pressure monitoring and office and home-based blood pressure (BP) monitoring are recommended for the early analysis of risks. Cardiovascular risks, end-organ damage, and renal disorders are the primary complications associated with diabetic hypertension that needs to be managed with the help of non-pharmacological and pharmacological interventions. The non-pharmacological interventions include the nutrition education of the patient to reduce the intake of salt, sodium, and trans fats and increase the consumption of nuts, fresh fruits, vegetables, and potassium-rich foods. It is also recommended to initiate 50 to 60 min of exercise three to four times a week since physical activity has shown to be more beneficial for hypertension control in Indian patients than dietary modulation. For the pharmacological management of hypertension in patients with T2DM, angiotensin II receptor blockers (ARBs) are recommended as the first line of therapy, demonstrating their superiority over other antihypertensive agents such as ACEi. However, most of the global hypertension guidelines recommend initiation with combination therapy to achieve better BP control in most patients and to reduce the risk of adverse events. For combination therapy, calcium channel blockers (CCBs) are recommended to be administered along with ARBs instead of beta-blockers or diuretics to avoid the risk of cardiovascular events and hyperglycaemia. Among the CCBs, novel molecules (e.g. cilnidipine) are recommended in combination with ARBs for better cardiovascular and reno-protection in diabetic hypertensive patients.

Lived Experience of Nurses in COVID-19 Units - A Phenomenological Study from Eastern India

Introduction: Nurses are the frontline workers who had to play multiple functions like in acute care, community, etc. but, it was stated that COVID-19 has caused immense trauma to nurses globally. Methods: A descriptive phenomenological study to explore the lived experience of nurses working in COVID-19 units was conducted among nine senior nursing officers recruited by purposive homogenous sampling and interviewed with an open-ended interview guide by ensuring data saturation. COREQ guideline were adopted for this qualitative study. Results: Qualitative data were analysed using Giorgi's framework, and themes and sub-themes were derived. The major themes that emerged in the present study were "Reactions and preparation", "Feelings and satisfaction in active duty", "Role of a helping hand", "Working experience in PPE", and "Pandemic and socialization". Each theme had further sub-themes to classify the verbatims. Conclusion: Most of the nurses had anxiety and prepared themselves to play with fire, had unrealistic hope, and mixed emotions, kept their family away and intentionally concealed information to reduce family's fear, were satisfied with training and preparation, and had unpleasant experiences with PPE, had to restrict their social activities and felt social stigma. It also concludes with the recommendation that warrants the need to improve their professional quality of life and working conditions by safeguarding nurses' physical and mental health.

National Hypertension Guidelines: A Review of the India Hypertension Control Initiative (IHCI) and Future Prospects

Hypertension is a silent killer; however, the treatment of hypertension is simple, effective, readily available, and needs to be continued lifelong. It is a significant health problem that is included under the umbrella of non-communicable disease conditions and has a strong alliance with cardiovascular morbidity and mortality. The India Hypertension Control Initiative (IHCI) is an extensive program in India that involves the Indian Council of Medical Research, the Ministry of Health and Family Welfare (Government of India), the state governments of India, and World Health Organization Country Office for India (WHO-India). The IHCI is a multi-partner initiative carried forward systemically across various states. The states are categorized into Grade I and Grade II. There is the involvement of specialized teams of cardiovascular experts and health officials to insure precise execution and seamless healthcare service. 

The implementation of the free and easy-to-use mobile application and software, Simple (Resolve to Save Lives, New York City, United States), in the analysis and storage of data, is a novel step taken to insure safe record keeping and follow-ups. Emphasis is on the adoption of demography-specific interventional methods and drugs, and proper acquisition and storage of these drugs is the key step. Treatment modalities involve the adoption of medicines and lifestyle modifications as a combined recipe. Advancements have been made in the area of drug development like gene therapies but they seem to show low success rates at the given moment. Adoption of lifestyle modifications along with medications is the gold standard treatment option. This review article aims to shed light on the current status of IHCI, its milestones, and the future of the initiative in India.

The burden of risk factors for non-communicable disease in rural Bihar, India: a comparative study with national health surveys

BACKGROUND

The incidence of non-communicable diseases (NCDs) is increasing in rural India. The National Family Health Survey-5 (NFHS-5) provides estimates of the burden of NCDs and their risk factors in women aged 15-49 and men aged 15-54 years. The aim of this study is to estimate the prevalence of hypertension and body-mass index (BMI) in adults aged 35-70 years in rural India and to compare these estimates, where age ranges overlap, to routinely available data.

METHODS

The Non-Communicable Disease in Rural India (NCDRI) Study was a cross-sectional household survey of 1005 women and 1025 men aged 35-70 conducted in Bihar in July 2019. Information was collected on personal characteristics, self-reported medical history and physical measurements (blood pressure, height and weight). Prevalence estimates for hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or diagnosed and treated for hypertension), and for underweight (body-mass index < 18.5 kg/m2), normal weight (18.5-25.0 kg/m2) and overweight (≥ 25.0 kg/m2) were calculated. Where age ranges overlapped, estimates from the NCDRI Study were compared to the NFHS-5 Survey.

RESULTS

In the NCDRI Study, the estimated prevalence of hypertension was 27.3% (N = 274) in women and 27.6% (N = 283) in men aged 35-70, which was three-times higher in women and over two-times higher in men than in the NFHS-5 Survey. One-quarter (23.5%; N = 236) of women and one-fifth (20.2%; N = 207) of men in the NCDRI Study were overweight, which was approximately 1.5 times higher than in the NFHS-5 Survey. However, where age groups overlapped, similar age-standardized estimates were obtained for hypertension and weight in both the NCDRI Study and the NFHS-5 Survey.

CONCLUSION

The prevalence of NCDs in rural India is higher than previously reported due to the older demographic in our survey. Future routine national health surveys must widen the age range of participants to reflect the changing disease profile of rural India, and inform the planning of health services.

Examining sex disparity in the association of waist circumference, waist-hip ratio and BMI with hypertension among older adults in India

Hypertension is a public health issue touted as a “silent killer” worldwide. The present study aimed to explore the sex differential in the association of anthropometric measures including body mass index, waist circumference, and waist-hip ratio with hypertension among older adults in India. The study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017–18. The sample contains 15,098 males and 16,366 females aged 60 years and above. Descriptive statistics (percentages) along with bivariate analysis were presented. Multivariable binary logistic regression analyses were used to examine the associations between the outcome variable (hypertension) and putative risk or protective factors. About 33.9% of males and 38.2% of females aged 60 years and above suffered from hypertension. After adjusting for the socioeconomic, demographic and health-behavioral factors, the odds of hypertension were 1.37 times (CI: 1.27–1.47), significantly higher among older adults who were obese or overweight than those with no overweight/obese condition. Older adults with high-risk waist circumference and waist-hip ratio had 1.16 times (CI: 1.08–1.25) and 1.42 times (CI: 1.32–1.51) higher odds of suffering from hypertension, respectively compared to their counterparts with no high-risk waist circumference or waist-hip ratio. The interaction effects showed that older females with overweight/obesity [OR: 0.84; CI: 0.61–0.74], high-risk waist circumference [OR: 0.89; CI: 0.78–0.99], and high-risk waist-hip ratio [OR: 0.90; CI: 0.83–0.97] had a lower chance of suffering from hypertension than their male counterparts with the similar anthropometric status. The findings suggested a larger magnitude of the association between obesity, high-risk waist circumference, high-risk waist-hip ratio and prevalent hypertension among older males than females. The study also highlights the importance of measuring obesity and central adiposity in older individuals and using such measures as screening tools for timely identification of hypertension.

Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India

Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.

Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60-108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8-40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2-26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.

Validity of self-reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

Self‐reported measures of health, in the context of developed countries, are well‐researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under‐researched and questionable in the context of low‐ and middle‐income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self‐reported hypertension with biometrically‐measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self‐reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub‐groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self‐reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy‐making in India be based more on an objective assessment of hypertension.

A Comparative Study of Baseline Heart Rate Variability, Sleep Quality, and Oxidative Stress Levels in Hypertensive Versus Normotensive Subjects: A Cross-Sectional Study

Objectives: To understand sleep quality, oxidative stress levels, and heart rate variability (HRV) in subjects with hypertension. This study aims to create baseline data in hypertensive subjects to research the possibility of further estimating the risk of developing cardiovascular mortality and morbidity in a patient with hypertension.

Design and methods: This analytical cross-sectional study, encompassing 128 study subjects of both genders, with 64 hypertensive subjects, analyse the co-relation of sleep quality, malondialdehyde, and heart rate variability in hypertensive and normotensive subjects. The study was done in a tertiary teaching institute in northern India for 14 months. Descriptive statistics were used, and the independent t-test, Mann-Whitney U test, and Chi-square were used to find the association among the variables. Linear regression was used to estimate the effect of blood pressure on malondialdehyde levels.

Results: Subjects with hypertension were found to have poor sleep quality (Global PSQI score ≥5, p=0.0001) and an increased malondialdehyde level (0.30303±0.17193 µM/L, p=0.0001). The hypertensive subjects were found to have lower parasympathetic activity as indicated by low high frequency (2.79463±473.220280; p=0.0001) and increased sympathetic activity; low frequency/high frequency (2.29823±2.792441; p=0.0001). Multivariate linear regression predicts that with one unit increase in systolic blood pressure, the malondialdehyde level increases by 0.006 units (p=0.002; 95% CI).

Conclusion: Among the hypertensive group, there is significantly increased oxidative stress level, poor quality of sleep, and increased sympathetic activity, thereby predisposing the subjects to increased risk of cardiac morbidity and mortality.

Automated Diagnosis and Assessment of Cardiac Structural Alteration in Hypertension Ultrasound Images

Hypertension (HTN) is a major risk factor for cardiovascular diseases. At least 45% of deaths due to heart disease and 51% of deaths due to stroke are the result of hypertension. According to research on the prevalence and absolute burden of HTN in India, HTN positively correlated with age and was present in 20.6% of men and 20.9% of women. It was estimated that this trend will increase to 22.9% and 23.6% for men and women, respectively, by 2025. Controlling blood pressure is therefore important to lower both morbidity and mortality. Computer-aided diagnosis (CAD) is a noninvasive technique which can determine subtle myocardial structural changes at an early stage. In this work, we show how a multi-resolution analysis-based CAD system can be utilized for the detection of early HTN-induced left ventricular heart muscle changes with the help of ultrasound imaging. Firstly, features were extracted from the ultrasound imagery, and then the feature dimensions were reduced using a locality sensitive discriminant analysis (LSDA). The decision tree classifier with contourlet and shearlet transform features was later employed for improved performance and maximized accuracy using only two features. The developed model is applicable for the evaluation of cardiac structural alteration in HTN and can be used as a standalone tool in hospitals and polyclinics.

Hypertension treatment cascade in India: results from National Noncommunicable Disease Monitoring Survey

Hypertension is a major risk factor for ischemic heart disease and stroke. We estimated prevalence, awareness, treatment, and control of hypertension along with its determinants in India. We used data from the National NCD Monitoring Survey-(NNMS-2017-2018) which studied one adult (18-69 years) from a representative sample of households across India and collected information on socio-demographic variables, risk factors for NCDs and treatment practices. Blood pressure was recorded digitally and hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg or currently on medications. Awareness was defined as being previously diagnosed with hypertension by a health professional; on treatment as taking a dose of medication once in the last 14 days and; control as SBP < 140 mmHg and DBP < 90 mmHg. Multivariate Logistic regression was performed to estimate determinants. Out of 10,593 adults with a blood pressure measurement (99.4%), 3017 (28.5%; 95% CI: 27.0-30.1) were found to have hypertension. Of these hypertensives, 840 (27.9%; 95% CI: 25.5-30.3) were aware, 438 (14.5%; 95% CI: 12.7-16.5) were under treatment and, 379 (12.6%; 95% CI: 11.0-14.3) were controlled. Significant determinants of awareness were being in the age group 50-69 years (aOR 2.45 95% CI: 1.63-3.69), women (1.63; 95% CI: 1.20-2.22) and from higher wealth quintiles. Those in the age group 50-69 (aOR 4.80; 95% CI: 1.74-13.27) were more likely to be under treatment. Hypertension control was poorer among urban participants (aOR 0.55; 95% CI: 0.33-0.90). Significant regional differences were noted, though without any clear trend. One-fifth of the patients were being managed at public facilities. The poor population-level hypertension control needs strengthening of hypertension services in the Universal Health Coverage package.

Decomposing rural-urban differences in successful aging among older Indian adults

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Management of American Heart Association/American College of Cardiology-Defined Stage 2 Hypertension by Cardiologists in India

Uncontrolled hypertension is an important cardiovascular risk factor and therefore requires effective approaches to patient management. This study assessed approaches to the management of patients with Stage 2 hypertension by cardiologists in India. This was a retrospective, multicenter, observational, case-based questionnaire study. Data on demographic characteristics, risk factors associated with Stage 2 hypertension, use of antihypertensive medications, side effects, and approaches to education for 2,540 patients were extracted from questionnaire responses provided by 508 cardiologists. The study population of patients with Stage 2 hypertension had a mean age of 55.0 years. Most of the patients (62.6%) were aged 30 to 60 years and diabetes mellitus was the most prevalent comorbidity (48.9%). Triple antihypertensive therapy was being used by 760 patients, and 634 and 1,146 patients were receiving 4 and 5 different antihypertensive medications, respectively. Telmisartan, amlodipine, chlorthalidone, hydrochlorothiazide, spironolactone, metoprolol, and prazosin were the commonly prescribed drugs. Ankle edema (27.7%) was the most frequent side effect of therapy. Pharmacotherapy was supported by patient education and lifestyle modifications for better blood pressure control. The standardized approach to the collection and assessment of these contemporary data provides useful insights into the characteristics and treatment of patients with Stage 2 hypertension in India.

Educational status and COVID-19 related outcomes in India: hospital-based cross-sectional study

OBJECTIVE

Association of educational status, as marker of socioeconomic status, with COVID-19 outcomes has not been well studied. We performed a hospital-based cross-sectional study to determine its association with outcomes.

METHODS

Successive patients of COVID-19 presenting at government hospital were recruited. Demographic and clinical details were obtained at admission, and in-hospital outcomes were assessed. Cohort was classified according to self-reported educational status into group 1: illiterate or ≤primary; group 2: higher secondary; and group 3: some college. To compare intergroup outcomes, we performed logistic regression.

RESULTS

4645 patients (men 3386, women 1259) with confirmed COVID-19 were recruited. Mean age was 46±18 years, most lived in large households and 30.5% had low educational status. Smoking or tobacco use was in 29.5%, comorbidities in 28.6% and low oxygen concentration (SpO₂ <95%) at admission in 30%. Average length of hospital stay was 6.8±3.7 days, supplemental oxygen was provided in 18.4%, high flow oxygen or non-invasive ventilation 7.1% and mechanical ventilation 3.6%, 340 patients (7.3%) died. Group 1 patients had more tobacco use, hypoxia at admission, lymphocytopaenia, and liver and kidney dysfunction. In group 1 versus groups 2 and 3, requirement of oxygen (21.6% vs 16.7% and 17.0%), non-invasive ventilation (8.0% vs 5.9% and 7.1%), invasive ventilation (4.6% vs 3.5% and 3.1%) and deaths (10.0% vs 6.8% and 5.5%) were significantly greater (p<0.05). OR for deaths were higher in group 1 (1.91, 95% CI 1.46 to 2.51) and group 2 (1.24, 95% CI 0.93 to 1.66) compared with group 3. Adjustment for demographic and comorbidities led to some attenuation in groups 1 (1.44, 95% CI 1.07 to 1.93) and 2 (1.38, 95% CI 1.02 to 1.85); this persisted with adjustments for clinical parameters and oxygen support in groups 1 (1.38, 95% CI 0.99 to 1.93) and 2 (1.52, 95% CI 1.01 to 2.11).

CONCLUSION

Low educational status patients with COVID-19 in India have significantly greater adverse in-hospital outcomes and mortality.

TRIAL REGISTRATION NUMBER

REF/2020/06/034036.

Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India

Background

Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India.

Method and findings

A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017–2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of–OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24–25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82–244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeff_poorest 11.27, CI 3.82,18.71; aCoeff_lower-middle 7.83, CI 0.65,15.00 and aCoeff_upper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure.

Conclusion

This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.

Identifying the latent classes of modifiable risk behaviours among diabetic and hypertensive individuals in Northeastern India: a population-based cross-sectional study

OBJECTIVE

To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors.

DESIGN

A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey.

SETTING AND PARTICIPANTS

Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women.

PRIMARY AND SECONDARY OUTCOME MEASURES

The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes.

RESULTS

Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol.

CONCLUSIONS

Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual.

A Retrospective, Observational, EMR-Based Real-World Evidence Study to Assess the Incidence of Pedal Edema in Essential Hypertensive Patients on Amlodipine or Cilnidipine

INTRODUCTION

Calcium channel blockers have pedal edema as one of the confining factors of treatment. A real-world study may help evident reality of the situation in regular Indian clinical practice. The aim of the study is to assess effectiveness and incidence of pedal edema in essential hypertensive patients treated with amlodipine or cilnidipine monotherapy.

METHODS

Retrospective EMR data of adult essential hypertensive patients, prescribed amlodipine (n = 800) or cilnidipine (n = 800) as monotherapy, were analyzed. Incidence of pedal edema from baseline visit was analyzed in terms of dose and duration of treatment. The changes in systolic (SBP) and diastolic blood pressure (DBP) from baseline and proportion of patients achieving target BP goals were assessed.

RESULTS

In amlodipine and cilnidipine groups, mean changes in SBP and DBP from baseline to end of the study period were 28.4 and 15.1 mmHg and 24.3 and 13.5 mmHg, respectively (p value <0.05). More than 50% of patients in both groups achieved BP goal at the end of the study (p value 0.266). In amlodipine group, total 23.9% reported pedal edema, while in cilnidipine, 27.6% (p value 0.0863). At the end of the study, 3.5% and 8.2% of patients remain with pedal edema, respectively, in both groups (pvalue <0.005).

CONCLUSION

Amlodipine demonstrated greater BP reduction at a lower average dose, better efficacy, and tolerability in terms of pedal edema count as a lesser number of patients reported edema at the end of the study and a higher percentage of patients continued the prescribed baseline dosage regimen as compared to cilnidipine. Thus, the study established amlodipine as an effective and well-tolerated antihypertensive for Indians.

A structured additive modeling of diabetes and hypertension in Northeast India

Background

Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India.

Methods

The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension.

Results

The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts.

Conclusion

Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

Quantifying population level hypertension care cascades in India: a cross-sectional analysis of risk factors and disease linkages

BACKGROUND

Hypertension is associated with higher morbidity and mortality burden, and is reported to pose severe repercussions on those above the age of 60 years. Despite the growing concern, empirical evidence providing nationally representative estimates of hypertension care cascades for the elderly population are inadequate in India. Therefore, the present study aims to quantify the magnitude of hypertension care cascades, identify the co-morbidities attributed to hypertension and recognize lifestyle modifications to reduce the instances of uncontrolled blood pressure among the elderly population in India.

METHOD

This study employed data on 28,109 elderly individuals from the Longitudinal Ageing Study in India, 2017-18. Descriptive and multivariable analyses were performed to identify the burden and correlates of hypertension and uncontrolled blood pressure levels. Population Attributable Risk was computed to identify deteriorating health implications and recognize viable solutions to improve the situation.

RESULTS

The findings suggest that elderly experiences loss at all stages of hypertension care, namely, at the level of measured hypertension (72.5%), diagnosis/awareness (57.3%), treatment (50.5%), and control (27.5%). The highest dip was observed at the level of blood pressure control. The findings hint towards the linkages between socio-economic, demographic, and lifestyle factors with hypertension and uncontrolled blood pressure levels. Caste, religion, living arrangement, MPCE quintile, residence, family history of hypertension, working status, and alcohol consumption were the significant predictors of uncontrolled hypertension. The findings quantified the proportion of diseased cases attributed to hypertension, and highlighted essential contributors of overall and uncontrolled hypertension.

CONCLUSIONS

There is an urgent need to improve access to cost-effective anti-hypertensive prescriptions to curtail the increasing burden of uncontrolled blood pressure and some other co-morbid diseases. Thus, if apprehended cautiously, findings from this study can serve to design practical approaches aimed at control, prevention, and management of hypertension among the elderly population of India.