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Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey

Journal of Human Hypertension (2024)Cite this article

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Abstract

Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India’s National Family Health Survey Fifth Round (2019–2021). The prevalence of hypertension among 204,054 older adolescents (15–19 years) was 5.08% (95% CI: 4.94–5.23%) wherein 42.26% (95% CI: 40.69–43.64%) were aware of their condition, 43.70% (95% CI: 41.73–45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83–87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.

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Fig. 1: Effective sample size.
Fig. 2: Awareness of being hypertensive.
Fig. 3: Under treatment for hypertension.
Fig. 4: Controlled blood pressure.

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Data availability

All data used in this analysis can be downloaded directly from the DHS program (after registration and statutory approval) at: https://dhsprogram.com/data/available-datasets.cfm.

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Acknowledgements

We would like to express our deepest gratitude to the International Institute for Population Sciences for giving us the NFHS dataset and authorizing us to conduct the research.

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Authors and Affiliations

  1. Indian Institute of Public Health- Delhi, Public Health Foundation of India, New Delhi, India

    Shubhanjali Roy, Mansi Malik & Saurav Basu

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Contributions

Shubhanjali Roy contributed to design, analysis and interpretation of the data, drafting the paper and revising the paper critically for important intellectual content, final approval of the paper submitted. Mansi Malik contributed to analysis and interpretation of the data, drafting the paper, final approval of the paper submitted. Saurav Basu contributed to conception and design, interpretation of the data, drafting the paper and revising the paper critically for important intellectual content, final approval of the paper submitted. We agree to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Saurav Basu.

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The authors declare no competing interests.

Ethics

This study is a secondary data analysis utilizing NFHS-5 survey data that is accessible in the public domain. The Demographic Health Survey (DHS), after assessing the submitted proposal, approved access to the dataset. Adult participants in the NFHS-5 survey provided their voluntary written and informed consent while minor participants provided informed assent with parental consent. The survey complies with the Declaration of Helsinki and received ethical approval from the International Institute of Population Sciences’ ethical review board (IIPS).

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Roy, S., Malik, M. & Basu, S. Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey. J Hum Hypertens (2024). https://doi.org/10.1038/s41371-024-00940-3

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