Singh Geetu, Agrawal Renu, Kumar Sanjeev, Kumar Shubham, Negi Rudresh, Goel Sonu, Agarwal Tanya
Department of Community Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
PLoS One. 2025 Jun 11;20(6):e0325437. doi: 10.1371/journal.pone.0325437. eCollection 2025.
Since the advent of American Joint National Commission (JNC-7) guidelines, epidemiological studies have reported that prehypertension is a common presentation in the general population, with a prevalence of 25% to 55% globally. The present study aimed to estimate the prevalence of prehypertension (elevated blood pressure or high normal BP) and its determinants based on different standard classifications using the large population-based data from the fourth and fifth rounds of National Family Health Surveys (NHFS), India. We also intended to identify the trends of prehypertension between NFHS-4 and NFHS-5 at national, state and district levels.
We analyzed the data from the National Family Health Surveys (NFHS) 4 and 5 conducted in 2015-16 and 2019-20, respectively. Prevalence of pre-hypertension and its equivalent terms, elevated blood pressure and high normal BP was reported as per the Joint National Committee (JNC 7), 2017 American College of Cardiology/American Heart Association (ACC/AHA), and Indian Guidelines for Hypertension (IGH -IV) respectively. GeoDa (spatial and cluster maps) was used to compute Local Indicators of Spatial Association (LISA). We also calculated Moran's Index to explain the data's overall clustering and project the strength and patterns of spatial autocorrelation to represent district-level results.
Prevalence of prehypertension (elevated blood pressure or high normal BP) showed an increasing trend across all three classifications from NFHS-4 to NFHS-5 in India (35.8% vs. 48.8% as per JNC 7, 6.1% vs 8.8% as per ACC/AHA and 12.5% vs 20.8% according to IGH-IV). Age > 29 years was significant risk factors for pre-hypertension in both the surveys as per JNC 7 and IGH -IV guidelines. Women had higher odds of having prehypertension according to all three guidelines in both surveys. Education had a protective effect across classifications as evident from NFHS-5 data, which was variable in the previous NFHS-4 survey. The prevalence of prehypertension (JNC 7/8) has increased above 50% in NFHS-5 survey in most states of India, namely, Delhi, most districts of Punjab, Himachal Pradesh, Haryana, Rajasthan, Uttarakhand, Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Jharkhand, Odisha, Manipur, Mizoram, Arunachal Pradesh, Tamil Nadu, Lakshadweep and Andaman and Nicobar Islands. However, Goa, Sikkim, Assam, Nagaland and West Bengal demonstrated a declining trend in prevalence of prehypertension. In NFHS-5, 117 districts were observed as hotspots ("high-high" clustering) clustered zones, mostly in Arunachal Pradesh, Rajasthan, Madhya Pradesh, Uttar Pradesh, and Punjab.
We found a high prevalence of prehypertension in large population based survey in Indian population. The findings also highlighted marked differences in estimates of prehypertension (elevated blood pressure or high normal BP) based on different classifications. These results will help guide researchers, public health policymakers and clinicians to uniformly define prehypertension for its effective management. These trends should be considered as an interim warning signal to formulate guidelines with strong implementation of interventions to prevent and control prehypertension and hypertension.
自美国国家联合委员会（JNC - 7）指南问世以来，流行病学研究报告称，高血压前期在普通人群中很常见，全球患病率为25%至55%。本研究旨在利用印度第四轮和第五轮全国家庭健康调查（NHFS）的大量基于人群的数据，根据不同的标准分类估算高血压前期（血压升高或血压正常高值）的患病率及其决定因素。我们还打算确定在国家、邦和地区层面上，NFHS - 4和NFHS - 5之间高血压前期的趋势。
我们分别分析了2015 - 16年和2019 - 20年进行的全国家庭健康调查（NFHS）4和5的数据。高血压前期及其等效术语，即血压升高和血压正常高值的患病率分别根据美国国家联合委员会（JNC 7）、2017年美国心脏病学会/美国心脏协会（ACC/AHA）以及印度高血压指南（IGH - IV）进行报告。使用GeoDa（空间和聚类地图）来计算空间关联局部指标（LISA）。我们还计算了莫兰指数，以解释数据的总体聚类情况，并预测空间自相关的强度和模式，以呈现地区层面的结果。
在印度，从NFHS - 4到NFHS - 5，所有三种分类中高血压前期（血压升高或血压正常高值）的患病率均呈上升趋势（根据JNC 7为35.8%对48.8%，根据ACC/AHA为6.1%对8.8%，根据IGH - IV为12.5%对20.8%）。根据JNC 7和IGH - IV指南，在两项调查中，年龄大于29岁都是高血压前期的重要危险因素。在两项调查中，根据所有三项指南，女性患高血压前期的几率都更高。从NFHS - 5数据可以明显看出，教育在所有分类中都具有保护作用，而在之前NFHS - 4调查中这种作用并不一致。在印度大多数邦，即德里、旁遮普邦的大多数地区、喜马偕尔邦、哈里亚纳邦、拉贾斯坦邦（Rajasthan）、北阿坎德邦、北方邦、恰蒂斯加尔邦、中央邦、贾坎德邦、奥里萨邦、曼尼普尔邦、米佐拉姆邦、阿鲁纳恰尔邦、泰米尔纳德邦、拉克沙群岛和安达曼和尼科巴群岛，NFHS - 5调查中高血压前期（JNC 7/8）的患病率已超过50%。然而，果阿邦、锡金邦、阿萨姆邦、那加兰邦和西孟加拉邦的高血压前期患病率呈下降趋势。在NFHS - 5中，观察到117个地区为热点（“高高”聚类）聚集区，主要分布在阿鲁纳恰尔邦、拉贾斯坦邦、中央邦、北方邦和旁遮普邦。
我们在基于印度人群的大规模调查中发现高血压前期患病率很高。研究结果还突出了基于不同分类对高血压前期（血压升高或血压正常高值）估计的显著差异。这些结果将有助于指导研究人员、公共卫生政策制定者和临床医生统一界定高血压前期，以便进行有效管理。这些趋势应被视为一个临时警示信号，以制定强有力实施干预措施的指南，预防和控制高血压前期及高血压。
