Original Article | Published:

Patterns and predictors of undiagnosed and uncontrolled hypertension: observations from a poor-resource setting

Journal of Human Hypertension volume 31, pages 5665 (2017) | Download Citation

Abstract

Early detection is the cornerstone of hypertension management; still majority remains undetected until complications arise, especially in poor-resource settings. Paucity of information regarding undiagnosed and uncontrolled hypertension in eastern India thus called for a detailed investigation involving a representative sample of adults in Malda, one of the poorest districts in the region. In a cross-sectional study, between October 2013 and July 2014, using multistage random sampling with probability-proportional-to-size, 18 028 consenting adults were interviewed. Diagnosed cases were defined as uncontrolled if they still had hypertensive level of blood pressure (according to JNC-VIII criteria) while those detected during this study were defined as undiagnosed. Descriptive and regression analyses were performed using SAS version 9.3.2. Among 18 028 participants, 4695 (26.04% (95% confidence intervals: 95% CI=25.40–26.68)) had hypertension, of which 3937 (83.86% (82.80–84.91)) were undiagnosed and 548 (72.30 (69.10–75.49)) had uncontrolled hypertension. Relatively older subjects (adjusted Odds ratio (aOR)41–60 years=0.34 (95% CI=0.26–0.43) and aOR>60 years=0.29 (0.21–0.38)), who were divorced/separated/widowed/widower (aOR=0.76 (0.61–0.95)), had higher education (aOR=0.61 (0.43–0.88)), better socio-economic status (SES) (aORMiddle=0.77 (0.60–0.99) and aORUpper=0.64 (0.48–0.85)) and urban residence (aOR=0.44 (0.36–0.55)) were less likely while subjects who belonged to backward castes (aOR=1.37 (1.15–1.64)) were more likely to have undiagnosed hypertension. Odds of having uncontrolled hypertension were higher among participants aged >60 years (aOR=2.25 (1.27–3.99)). Burden of hypertension (diagnosed and undiagnosed) was high in Malda district of West Bengal. Significant predictors of undiagnosed hypertension were young age, backward caste, poor education and lower SES, while older subjects had poor control. Thus, appropriate surveillance targeting these at-risk groups might be effective in controlling hypertension in similar poor-resource settings.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , , , , et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224–2260.

  2. 2.

    World Health Day 2013: measure your blood pressure, reduce your risk, Media centre, World Health Organization (WHO), 2013. Available from .

  3. 3.

    , , , , . Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367(9524): 1747–1757.

  4. 4.

    , , , , , et al. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens 2000; 14(10–11): 749–763.

  5. 5.

    . Trends in hypertension epidemiology in India. J Hum Hypertens 2004; 18(2): 73–78.

  6. 6.

    , , , . Responding to the threat of chronic diseases in India. Lancet 2005; 366(9498): 1744–1749.

  7. 7.

    , . Social determinants of cardiovascular disease outcomes in Indians. Indian J Med Res 2010; 132: 617–622.

  8. 8.

    Controlling high blood pressure, Key messages of World Health Day 2013. WHO global health days. Available from .

  9. 9.

    , , , , , et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 2014; 32(6): 1170–1177.

  10. 10.

    , , , , , 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 2012; 14(1): 8–15.

  11. 11.

    The Seventh Report of the Joint national Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). National Heart, Lung and Blood Institute, US Department of Health and Human Services, 2004. Available from .

  12. 12.

    , , , , . Prevalence, awareness and control of hypertension in Chennai—The Chennai Urban Rural Epidemiology Study (CURES-52). J Assoc Physicians India 2007; 55: 326–332.

  13. 13.

    , , , , , . Undiagnosed hypertension in a rural district in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES). J Hum Hypertens 2015; 30(4): 252–259.

  14. 14.

    , , , , , et al. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant 2010; 25(5): 1567–1575.

  15. 15.

    , , , , , et al. Prevalence and risk factors for prehypertension and hypertension in five Indian cities. Acta Cardiol 2011; 66(1): 29–37.

  16. 16.

    , , , , , et al. Prevalence, awareness and control of hypertension in rural communities of Himachal Pradesh. J Assoc Physicians India 2010; 58(423-424): 429.

  17. 17.

    , . Salt intake and hypertension: walking the tight rope. J Assoc Physicians India 2007; 55: 401–403.

  18. 18.

    , , , , . Dietary salt intake and hypertension in an urban south Indian population—[CURES - 53]. J Assoc Physicians India 2007; 55: 405–411.

  19. 19.

    , , , , , et al. Prevalence, risk factors and awareness of hypertension in India: a systematic review. J Hum Hypertens 2013; 27(5): 281–287.

  20. 20.

    , . Prevalence of hypertension and sociodemographic factors within the Scheduled Caste community of the District Nadia, West Bengal, India. High Blood Press Cardiovasc Prev 2011; 18(4): 179–185.

  21. 21.

    , , , . Hypertension and cardiovascular health in Venezuela and Latin American countries. J Hum Hypertens 2000; 14(Suppl 1): S2–S5.

  22. 22.

    Hypertension Study Group. Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study. Bull World Health Organ 2001; 79(6): 490–500.

  23. 23.

    , . Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension 2013; 62(1): 18–26.

  24. 24.

    , , , , . Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in South India. Int J Public Health 2012; 57(1): 87–94.

  25. 25.

    , , , , , . Hypertension in the elderly: prevalence and health seeking behavior. N Am J Med Sci 2012; 4(11): 558–562.

  26. 26.

    , , , , , et al. Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey. J Hypertens 2012; 30(1): 177–187.

  27. 27.

    , , , , . Incidence of hypertension and its risk factors in rural Kerala, India: a community-based cohort study. Public Health 2012; 126(1): 25–32.

  28. 28.

    , , , , , et al. Prevalence & risk factors of pre-hypertension & hypertension in an affluent north Indian population. Indian J Med Res 2008; 128(6): 712–720.

  29. 29.

    , , . Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Int J Med Sci 2005; 2(2): 70–78.

  30. 30.

    , , , , , . The prevalence of hypertension and hypertension risk factors in a rural Indian community: a prospective door-to-door study. J Cardiovasc Dis Res 2012; 3(2): 117–123.

  31. 31.

    , , , , , et al. Age-dependent gender differences in hypertension management. J Hypertens 2011; 29(5): 1005–1011.

  32. 32.

    , , , , , et al. Burden and predictors of hypertension in India: results of SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2014; 15: 42.

  33. 33.

    , , , , , et al. Normotension, prehypertension, and hypertension in urban middle-class subjects in India: prevalence, awareness, treatment, and control. Am J Hypertens 2013; 26(1): 83–94.

  34. 34.

    , . Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003; 290(2): 199–206.

  35. 35.

    , , , . Treatment seeking behavior and health care expenditure incurred for hypertension among elderly in urban slums of Belgaum City. Community Med 2013; 4(2): 227–230.

Download references

Acknowledgements

The study was funded (Grant No. 65/56/2012-13ECD-II) by Indian Council of Medical Research (http://icmr.nic.in/Grants/Grants.html). We are hereby acknowledging our gratitude to Professor Dr VI Mathan (Former Chair, National Institute of Epidemiology, Chennai and Chairman of the Scientific Advisory Committee, NICED, Kolkata) and Dr Sekhar Chakrabarti (Scientist G and Director in Charge, National Institute of Cholera and Enteric Diseases, Kolkata) for critically reviewing the proposal and the result. We also acknowledge the support of Dr VM Katoch (Director General, Indian Council of medical Research, Government of India) and Dr Rashmi Arora (Scientist G, Indian Council of Medical Research) for providing necessary logistic and administrative support. The Office of the Chief Medical Officer of Malda provided necessary permission and logistic support for the study. In addition, we also acknowledge the cooperation of the participants and the project staff.

Author information

Affiliations

  1. Department of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India

    • S Kanungo
    • , T Mahapatra
    • , K Bhowmik
    • , J Saha
    • , S Mahapatra
    • , D Pal
    •  & K Sarkar
  2. Department of Community Medicine, Burdwan Medical College, Burdwan, West Bengal, India

    • R Roy
  3. Principal, Malda Medical College, Malda, West Bengal, India

    • U K Bhadra

Authors

  1. Search for S Kanungo in:

  2. Search for T Mahapatra in:

  3. Search for K Bhowmik in:

  4. Search for J Saha in:

  5. Search for S Mahapatra in:

  6. Search for D Pal in:

  7. Search for R Roy in:

  8. Search for U K Bhadra in:

  9. Search for K Sarkar in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to K Sarkar.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/jhh.2016.30

Further reading