Hypertension in India
- High blood pressure (BP) is a major public health problem in India and its prevalence is rapidly increasing among both urban and rural populations.1, 2 In fact, hypertension is the most prevalent chronic disease in India.
- The prevalence of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults. The number of people with hypertension is projected to increase from 118 million in 2000 to 214 million in 2025, with nearly equal numbers of men and women.3
- A survey of 26,000 adults in South India showed a hypertension prevalence of 20% (men 23% and women 17%) but 67% of those with hypertension were unaware of their diagnosis. Majority of hypertensive subjects still remain undetected and the control of hypertension is also inadequate. This calls for urgent prevention and control measures for hypertension.4 See Figure 107.
- Recent (2012) studies show that for every known person with hypertension there are two persons with either undiagnosed hypertension or prehypertension (Figure 106).8
- Reducing blood pressure can decrease cardiovascular risk and this can be achieved by lifestyle measures in mild cases and should be the initial approach to hypertension management in all cases. This includes dietary interventions weight reduction, tobacco cessation, and physical activity.1
- Dietary interventions include; reducing salt, increasing potassium, and alcohol avoidance. But unlike in Western countries, stress management is often given greater emphasis in India.
- A number of safe and effective medications are available for treatment of high blood pressure. These include older molecules such as thiazide diuretics, beta-blocking agents, calcium channel blockers (CCB) and newer molecules, such as, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB). In view of the recent clinical trials data, some international guidelines suggest that CCB, ACE inhibitors or ARB and not beta-blockers or diuretics should be the initial therapy in hypertension management.1 The former however, are much more expensive and beyond the affordability in many poor income countries.
- Because of the heightened risk, the recommended targets are lower for all Indians<130/85 and <120/80 for those with diabetes or heart failure.5, 6
- Comprehensive hypertension management should focus not only on reducing the blood pressure, but reducing the cardiovascular risk by lifestyle measures, lipid management, smoking cessation, and regular exercise.1, 7
1. Gupta R, Guptha S. Strategies for initial management of hypertension. Indian J Med Res. Nov 2010;132(5):531-542.
2. Gupta R, al-Odat NA, Gupta VP. Hypertension epidemiology in India: meta-analysis of 50 year prevalence rates and blood pressure trends. J Hum Hypertens. Jul 1996;10(7):465-472.
3. Reddy KS. Regional case studies–India. Nestle Nutr Workshop Ser Pediatr Program. 2009;63:15-24; discussion 41-16, 259-268.
4. Mohan V, Deepa M, Farooq S, Datta M, Deepa R. Prevalence, awareness and control of hypertension in Chennai–The Chennai Urban Rural Epidemiology Study (CURES-52). J Assoc Physicians India. May 2007;55:326-332.
5. Enas EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.
6. Enas EA, Singh V, Munjal YP, Bhandari S, Yadave RD, Manchanda SC. Reducing the burden of coronary artery disease in India: challenges and opportunities. Indian Heart J. Mar-Apr 2008;60(2):161-175.
7. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic USA; 2011.
8. Joshi SR, Saboo B, Vadivale M, et al. Prevalence of Diagnosed and Undiagnosed Diabetes and Hypertension in India-Results from the Screening India’s Twin Epidemic (SITE) Study. Diabetes Technol Ther. Jan 2012;14(1):8-15.