Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Factors associated with awareness, treatment and control of hypertension in a disadvantaged rural Indian population

Journal of Human Hypertension volume 31, pages 347–353 (2017)Cite this article

Subjects

Abstract

The aim of this study was to identify factors associated with awareness, treatment and control of hypertension in a rural setting in India. Following screening of the population, all individuals with hypertension (blood pressure (BP) ⩾140/90 mm Hg or taking antihypertensive medications) were invited to participate in this study. We measured BP, height, weight, skinfolds, waist and hip circumference, and administered a questionnaire to obtain information regarding socioeconomic and behavioural characteristics. Multivariable logistic regression was used to determine factors associated with awareness, treatment and control of hypertension. We recruited 277 individuals with hypertension. Awareness (43%), treatment (33%) and control (27%) of hypertension were poor. Greater distance to health services (odds ratio (OR) 0.56 (95% confidence interval (CI)) 0.32–0.98) was associated with poor awareness of hypertension while having had BP measured within the previous year (OR 4.72, 95% CI 2.71–8.22), older age and greater per cent body fat were associated with better awareness. Factors associated with treatment of hypertension were having had BP measured within the previous year (OR 6.18, 95% CI 3.23–11.82), age ⩾65 years, physical inactivity and greater per cent body fat. The only factor associated with control of hypertension was greater per cent body fat (OR 1.05, 95% CI 1.01–1.11). Improving geographic access and utilisation of health services should improve awareness and treatment of hypertension in this rural population. Further research is necessary to determine drivers of control.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365 (9455): 217–223.

    Article  PubMed  Google Scholar 

  3. Pradeepa R, Mohan V . Hypertension & pre-hypertension in developing countries. Indian J Med Res 2008; 128: 688–690.

    CAS  PubMed  Google Scholar 

  4. Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Reddy KS . Hypertension control in developing countries: generic issues. J Hum Hypertens 1996; 10 (Suppl 1): S33–S38.

    PubMed  Google Scholar 

  6. Quasem I, Shetye MS, Alex SC, Nag AK, Sarma PS, Thankappan KR et al. 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.

    Google Scholar 

  7. Knight EL, Bohn RL, Wang PS, Glynn RJ, Mogun H, Avorn J . Predictors of uncontrolled hypertension in ambulatory patients. Hypertension 2001; 38 (4): 809–814.

    Article  CAS  PubMed  Google Scholar 

  8. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. ESH/ESC guidelines for themanagement of arterial hypertension The Task Force for the management ofarterial hypertension of the European Society ofHypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31 (7):1281–1357.

    Article  CAS  PubMed  Google Scholar 

  9. Zhang XP, Zhu MM, Dib HH, Hu J, Tang SC, Zhong T et al. Knowledge, awareness, behavior (KAB) and control of hypertension among urban elderly in Western China. Int J Cardiol 2009; 137 (1): 9–15.

    Article  PubMed  Google Scholar 

  10. World Health Organisation. Hypertension control. Report of a WHO Expert Committee. WHO: Geneva, Switzerland, 1996. WHO Technical Report Series 862.

  11. Antikainen RL, Moltchanov VA, Chukwuma C Sr, Kuulasmaa KA, Marques-Vidal PM, Sans S et al. Trends in the prevalence, awareness, treatment and control of hypertension: the WHO MONICA Project. Eur J Cardiovasc Prev Rehabil 2006; 13 (1): 13–29.

    PubMed  Google Scholar 

  12. Thrift AG, Evans RG, Kalyanram K, Kartik K, Fitzgerald SM, Srikanth V . Gender-specific effects of caste and salt on hypertension in poverty: a population-based study. J Hypertens 2011; 29: 443–450.

    Article  CAS  PubMed  Google Scholar 

  13. World Health Organisation. STEPwise Approach to Chronic Disease Surveillance (STEPS). Training and Practical Guides Overview. WHO: Geneva, Switzerland, 2008.

  14. Bull FC, Maslin TS, Armstrong T . Global Physical Activity Questionnaire (GPAQ): nine country reliability and validity study. J Phys Activity Health 2009; 6 (6): 790–804.

    Article  Google Scholar 

  15. Sharma U, Kishore J, Garg A, Anand T, Chakraborty M, Lali P . Dyslipidemia and associated risk factors in a resettlement colony of Delhi. J Clin Lipidol 2013; 7 (6): 653–660.

    Article  PubMed  Google Scholar 

  16. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25 (3): 305–313.

    Article  CAS  PubMed  Google Scholar 

  17. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163–170.

    CAS  PubMed  Google Scholar 

  18. Durnin JVGA, Womersley J . Body fat assessed from total-body density and its estimation from skinfold thickness—measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32 (1): 77–97.

    Article  CAS  PubMed  Google Scholar 

  19. Siri WE . Body-composition from fluid spaces and density—analysis of methods. Nutrition 1993; 9: 481–491.

    Google Scholar 

  20. Nayar KR . Social exclusion, caste & health: a review based on the social determinants framework. Indian J Med Res 2007; 126 (4): 355–363.

    CAS  PubMed  Google Scholar 

  21. Busingye D, Pedigo A, Odoi A . Temporal changes in geographic disparities in access to emergency heart attack and stroke care: are we any better today? Spat Spatiotemporal Epidemiol 2011; 2 (4): 247–263.

    Article  PubMed  Google Scholar 

  22. Pedigo AS, Odoi A . Investigation of disparities in geographic accessibility to emergency stroke and myocardial infarction care in east tennessee using geographic information systems and network analysis. Ann Epidemiol 2010; 20 (12): 924–930.

    Article  PubMed  Google Scholar 

  23. Stock R . Distance and the utilization of health facilities in rural Nigeria. Soc Sci Med 1983; 17 (9): 563–570.

    Article  CAS  PubMed  Google Scholar 

  24. Peat JK, Barton B . Medical Statistics: A Guide to Data Analysis and Critical Appraisal. Blackwell Publishing, Massachusetts, USA, 2005.

    Book  Google Scholar 

  25. Buor D . Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana. Int J Health Plann Manage 2003; 18 (4): 293–311.

    Article  PubMed  Google Scholar 

  26. Baker J, Liu L . The determinants of primary health care utilization: a comparison of three rural clinics in Southern Honduras. GeoJournal 2006; 66 (4): 295–310.

    Article  Google Scholar 

  27. Kinman EL . Evaluating health service equity at a primary care clinic in Chilimarca, Bolivia. Soc Sci Med 1999; 49 (5): 663–678.

    Article  CAS  PubMed  Google Scholar 

  28. Pereira M, Lunet N, Azevedo A, Barros H . Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009; 27 (5): 963–975.

    Article  CAS  PubMed  Google Scholar 

  29. Ma WJ, Tang JL, Zhang YH, Xu YJ, Lin JY, Li JS et al. Hypertension prevalence, awareness, treatment, control, and associated factors in adults in Southern China. Am J Hypertens 2012; 25 (5): 590–596.

    Article  PubMed  Google Scholar 

  30. Muntner P, Gu D, Wu X, Duan X, Wenqi G, Whelton PK et al. Factors associated with hypertension awareness, treatment, and control in a representative sample of the Chinese population. Hypertension 2004; 43 (3): 578–585.

    Article  CAS  PubMed  Google Scholar 

  31. Joshi R, Chow CK, Raju PK, Raju KR, Gottumukkala AK, Reddy KS et al. The Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS) a cluster randomized trial. J Am Coll Cardiol 2012; 59 (13): 1188–1196.

    Article  PubMed  Google Scholar 

  32. Praveen D, Patel A, Raghu A, Clifford GD, Maulik PK, Mohammad Abdul A et al. SMARTHealth India: development and field evaluation of a mobile clinical decision support system for cardiovascular diseases in rural India. JMIR Mhealth Uhealth 2014; 2 (4): e54.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S . Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol 2014; 43 (1): 116–128.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bovet P, Ross AG, Gervasoni JP, Mkamba M, Mtasiwa DM, Lengeler C et al. Distribution of blood pressure, body mass index and smoking habits in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status. Int J Epidemiol 2002; 31 (1): 240–247.

    Article  PubMed  Google Scholar 

  35. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L et al. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999; 21 (5-6): 1009–1060.

    Article  CAS  PubMed  Google Scholar 

  36. Diggle P . Analysis of Longitudinal Data. 2nd edn. Oxford University Press: New York, NY, USA, 2002.

    Google Scholar 

  37. Lavrakas PJ . Encyclopedia of Survey Research Methods. SAGE Publications: Thousand Oaks, CA, USA, 2008.

    Book  Google Scholar 

  38. Ray N, Ebener S . AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients. Int J Health Geogr 2008; 7: 63.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the health-care workers and study staff, who undertook the fieldwork and data collection for this study. DB is grateful for financial support received from the Monash University Postgraduate Publications Award. The project was funded by project grants from the National Health & Medical Research Council (NHMRC), Australia (1005740 and 1040030). AGT was supported by a senior research fellowship from the NHMRC, Australia (1042600). VKS was supported by an NHMRC Career Development Fellowship (1061457) and a Heart Foundation Future Leader Fellowship (100089). DB was supported by a Monash Faculty of Medicine International Postgraduate Scholarship and a Monash Graduate Scholarship.

Author information

Authors and Affiliations

  1. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia

    D Busingye, S Arabshahi, V K Srikanth, M A Riddell, O Suresh & A G Thrift

  2. Department of Physiology, Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia

    R G Evans

  3. Rishi Valley Rural Health Centre, Rishi Valley, Andhra Pradesh, India

    K Kartik, K Kalyanram & O Suresh

  4. School of Earth, Atmosphere and Environment, Monash University, Clayton, Victoria, Australia

    X Zhu

  5. Florey Neuroscience Institutes, Melbourne, Victoria, Australia

    A G Thrift

Authors
  1. D Busingye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Arabshahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R G Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V K Srikanth
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Kartik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K Kalyanram
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M A Riddell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. X Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O Suresh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A G Thrift
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D Busingye.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Journal of Human Hypertension website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Busingye, D., Arabshahi, S., Evans, R. et al. Factors associated with awareness, treatment and control of hypertension in a disadvantaged rural Indian population. J Hum Hypertens 31, 347–353 (2017). https://doi.org/10.1038/jhh.2016.85

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.85

This article is cited by

Search

Advanced search

Quick links