ABSTRACT
Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.
ABSTRACT
Background & objectives: It was hypothesized that both thrombogenic and atherogenic factors may be responsible for premature coronary heart disease (CHD) in young Indians. A case-control study was performed to determine cardiovascular risk factors in young patients with CHD in India. Methods: Successive consenting patients <55 yr with an acute coronary event or recent diagnosis of CHD were enrolled (cases, n=165). Age- and gender-matched subjects with no clinical evidence of CHD were recruited as controls (n=199). Demographic, anthropometric, clinical, haematological, and biochemical data were obtained in both groups. Univariate and multivariate logistic regression were performed to identify important risk factors. Results: In cases vs. controls mean systolic BP, diastolic BP, platelet counts, LDL cholesterol, non-HDL cholesterol, triglycerides, and fibrinogen were higher and HDL cholesterol lower (P<0.001). The presence of current smoking, low fruit and vegetables intake, high fat intake, hypertension, diabetes, low HDL cholesterol, and high LDL cholesterol, total:HDL ratio, fibrinogen and homocysteine was significantly higher in cases (P<0.05). Multivariate logistic regression analysis (age adjusted odds ratio, 95% confidence intervals) revealed that smoking (19.41, 6.82-55.25), high fat intake (1.66, 1.08-2.56), low fruit and vegetables intake (1.99, 1.11-3.59), hypertension (8.95, 5.42-14.79), high LDL cholesterol [2.49 (1.62-3.84)], low HDL cholesterol (10.32, 6.30-16.91), high triglycerides (3.62, 2.35-5.59) high total:HDL cholesterol (3.87, 2.35-5.59), high fibrinogen (2.87, 1.81-4.55) and high homocysteine (10.54, 3.11-35.78) were significant. Interpretation & conclusions: Our results showed that thrombotic (smoking, low fruit/vegetables intake, fibrinogen, homocysteine) as well as atherosclerotic (hypertension, high fat diet, dyslipidaemia) risk factors were important in premature CHD. Multipronged prevention strategies are needed in young Indian subjects.