Theilmann Michaela, Mani Sneha Sarah, Geldsetzer Pascal, Patel Shivani A, Ali Mohammed K, Thirumurthy Harsha, Narayan K M Venkat, Mohan Viswanathan, Tandon Nikhil, Prabhakaran Dorairaj, Sudharsanan Nikkil
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
BMJ Glob Health. 2025 Jun 13;10(6):e017167. doi: 10.1136/bmjgh-2024-017167.
As part of India's efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programmes in India. Using six waves of population-representative cohort data (N=15574), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. We find that measuring individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.12 percentage points (pp), 95% CI -1.39 to 1.75), treatment (-0.16 pp, 95% CI -2.18 to 1.03), or change in BP (systolic: -0.96mm Hg, 95% CI -5.63 to 1.14; diastolic: 0.21, 95% CI -1.65 to 1.65). Our heterogeneity analyses suggest that home-based screening may reduce systolic BP for women with secondary education and women living in Chennai. However, we find null effects for diagnosis and treatment among these subpopulations and in all outcome variables across the other subpopulations and alternative specifications. Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioural barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for India's efforts to achieve universal health coverage.
作为印度扩大基层医疗服务努力的一部分，几个邦政府正在实施或考虑开展基于家庭的高血压筛查项目，以提高全人群的诊断率和血压控制率。然而，关于印度基于家庭的筛查项目有效性的证据有限。利用六波具有人群代表性的队列数据（N = 15574），我们采用回归断点设计的一种新应用方法，估计了基于家庭的高血压筛查干预对诊断、治疗和血压的因果效应。我们发现，在家中测量个体血压并向血压升高者提供健康信息和转诊，并没有显著改善高血压诊断（0.12个百分点（pp），95%置信区间为 -1.39至1.75）、治疗（-0.16 pp，95%置信区间为 -2.18至1.03）或血压变化（收缩压：-0.96毫米汞柱，95%置信区间为 -5.63至1.14；舒张压：0.21，95%置信区间为 -1.65至1.65）。我们的异质性分析表明，基于家庭的筛查可能会降低受过中等教育的女性以及居住在金奈的女性的收缩压。然而，我们发现这些亚人群在诊断和治疗方面以及其他亚人群和替代规格的所有结局变量中均无显著效果。我们的研究结果表明，在印度，对自身高血压状况缺乏了解可能不是诊断和治疗率低的主要原因，其他结构和行为障碍可能更为相关。调整筛查工作以应对这些额外障碍对于印度实现全民健康覆盖的努力至关重要。
