Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study

Abstract

Background Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. Methods and findings We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017–2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%–46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%–56.5%) had been diagnosed, 38.9% (95% CI 38.1%–39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%–32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14–1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61–0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68–1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86–1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00–1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10–1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p Conclusions Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment. Jinkook Lee and colleagues investigate hypertension management and its association with healthcare access in middle-aged and older adults in India. Author summary Why was this study done? Hypertension is one of the most important drivers of the rising mortality and disability associated with cardiovascular diseases in India. Current knowledge about hypertension management among middle-aged and older adults in India is limited. Striking disparities in access to healthcare exist in India, and access to healthcare might be tied to hypertension awareness and treatment. What did the researchers do and find? We developed a nationally representative cohort study, the Longitudinal Aging Study in India (N = 72,262), and investigated hypertension prevalence, awareness, treatment, and control based on both self-report of diagnosis and blood pressure measurement. Among hypertensive adults aged 45 years and older, 55.7% had been told by a physician that they had hypertension, 38.9% took antihypertensive medication, and 31.7% kept their blood pressure controlled, and large variations in hypertension care were found across states and sociodemographic groups. Access to healthcare was a key predictor of hypertension awareness and treatment, and access to a public health center was especially critical for individuals in the most economically disadvantaged group to get access to treatment. What do these findings mean? Striking disparities in hypertension awareness, treatment, and control exist in India, and access to healthcare is tied to these disparities. Hypertension management has improved much in India from 2010 to 2017–2019, and health insurance expansion and growth in public healthcare facilities are important contributors to this improvement. Comparisons between 2010 and 2017–2019 were based on data from only 4 states, and therefore their generalizability to other states is limited.