Rao Guthi Visweswara, Sujith Kumar D S, Kumar Sanjeev, Kondagunta Nagaraj, Raj Sonika, Goel Sonu, Ojah Pratyashee
Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India.
Department of Community and Family Medicine, AIIMS, Bhopal, India.
Lancet Reg Health Southeast Asia. 2023 Sep 22;23:100271. doi: 10.1016/j.lansea.2023.100271. eCollection 2024 Apr.
Only a proportion of adults with hypertension are diagnosed and receive recommended prescriptions despite the availability of inexpensive and efficacious treatment. We aimed to estimate the prevalence of different stages of hypertension treatment cascade among the reproductive age groups in India at the national and state levels. We also identified the predictors of different stages of the hypertension treatment cascade.
We used the nationally representative data from National Family Health Survey (NFHS)-5. We included all the males (15-54 years) and females aged 15-49. Socio-demographic factors, anthropometric measurements, habits, comorbid conditions, and healthcare access stratified the stages of the hypertension treatment cascade among hypertensives. We used multinomial logistic regression to identify the determinants of the treatment cascade levels.
We had data from 1,267,786 individuals. The national prevalence of hypertension was 18.3% (95% CI: 18.1%-18.4%). Men (21.6%, 95% CI: 21.5%-21.7%) were found to have a higher prevalence as compared to women (14.8%, 95% CI: 14.7%-14.9%). Among hypertensive individuals, 70.5% (95% CI: 70.3%-70.7%) had ever received a BP measurement ("screened"), 34.3% (95% CI: 34.1%-34.5%) had been diagnosed prior to the survey ("aware"), 13.7% (95% CI: 13.5%-13.8%) reported taking a prescribed anti-hypertensive drug ("under treatment"), and 7.8% (95% CI: 7.7%-7.9%) had their BP under control ("controlled"). Males, illiterates, poor, never married, residents of rural areas, smokers/tobacco users, and alcoholic users were less likely to be in any of the treatment cascades.
The prevalence of hypertension in India is high. The "Rule of half" of hypertension does not apply to India as the proportion of people screened, aware of their hypertension status, treated, and controlled are lower than 50% at each stage. Program managers must improve access to hypertension diagnosis and treatment, especially among men in rural areas and populations with lower household wealth.
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尽管有廉价且有效的治疗方法，但只有一部分患有高血压的成年人得到诊断并接受推荐的处方治疗。我们旨在估计印度全国和各邦育龄人群中高血压治疗级联不同阶段的患病率。我们还确定了高血压治疗级联不同阶段的预测因素。
我们使用了来自全国代表性的第五轮全国家庭健康调查（NFHS-5）的数据。我们纳入了所有年龄在15 - 54岁的男性以及15 - 49岁的女性。社会人口统计学因素、人体测量数据、生活习惯、合并症以及医疗服务可及性对高血压患者的高血压治疗级联阶段进行了分层。我们使用多项逻辑回归来确定治疗级联水平的决定因素。
我们有来自1,267,786人的数据。全国高血压患病率为18.3%（95%置信区间：18.1% - 18.4%）。与女性（14.8%，95%置信区间：14.7% - 14.9%）相比，男性（21.6%，95%置信区间：21.5% - 21.7%）的患病率更高。在高血压患者中，70.5%（95%置信区间：70.3% - 70.7%）曾接受过血压测量（“筛查”），34.3%（95%置信区间：34.1% - 34.5%）在调查前已被诊断（“知晓”），13.7%（95%置信区间：13.5% - 13.8%）报告正在服用处方抗高血压药物（“接受治疗”），7.8%（95%置信区间：7.7% - 7.9%）的血压得到控制（“控制良好”）。男性、文盲、贫困人口、未婚者、农村居民、吸烟者/烟草使用者以及酗酒者处于任何治疗级联阶段的可能性较小。
印度高血压患病率很高。高血压的“半数法则”不适用于印度，因为在每个阶段接受筛查、知晓自己高血压状况、接受治疗以及血压得到控制的人群比例均低于50%。项目管理者必须改善高血压诊断和治疗的可及性，尤其是农村地区的男性和家庭财富较低的人群。
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