New Delhi, July 23: High blood pressure remains poorly controlled in a vast majority of patients despite a rapid rise in the prevalence of hypertension over the past 20 years, a study across India's National Capital Region (NCR) has suggested.
Doctors at the All India Institute of Medical Sciences, New Delhi, and collaborating researchers say the study has revealed a "disturbing trend" that while more people are showing up with high blood pressure, the proportion of patients on adequate treatment has dropped.
Their study found prevalence of hypertension increased from 23 per cent to 42 per cent in urban NCR and 11 per cent to over 28 per cent in rural NCR between 1991-94 and 2010-12, a higher rise among rural people long seen as more active and consuming better diets than urban people.
However, the study did not find significant differences in levels of awareness and treatment and control rates between the two surveys two decades apart. The proportion of patients on treatment for hypertension barely increased to 32.3 per cent during the 2010-12 period from 32 per cent during 1991-94.
The number of men whose blood pressure was well under control actually dropped to 12.8 per cent in 2010-12 from about 14.4 per cent two decades ago. The proportion of women with blood pressure under control increased mildly to 18 per cent from about 15 per cent two decades ago.
The study's findings have just been published in the journal BMJ Open.
In rural areas, both awareness and control have increased - awareness has tripled from 7 per cent to 21 per cent, while adequate control through treatment has increased from 2.5 per cent to 8 per cent over the past two decades.
Cardiologist Ambuj Roy at AIIMS, the study's lead author, and his colleagues say their findings underscore the need for "urgent" strategies to lower blood pressure in the community and raise awareness, treatment and control among patients with hypertension, which is largely an asymptomatic disorder.
"Patients and doctors are probably both responsible for the low control levels," said Dorairaj Prabhakaran, cardiologist and vice-president for research at the Public Health Foundation of India, a New Delhi-based research and training institution, and a study co-author.
"Some doctors may see a reading, decide to wait, and the patient doesn't come back for follow-up. Blood pressure medication in almost all people is expected to be lifelong treatment, but some people after a year of therapy may just stop taking their medication," Prabhakaran said.
The researchers caution that the worsening of population-level prevalence of hypertension is significant because multiple earlier studies have indicated that even small shifts in prevalence can lead to large increases in the burden of cardiovascular diseases.
The study found that among both populations surveyed, one during 1991-94 and the other during 2010-12, people who used alcohol and had high fasting blood glucose levels were at higher risk of hypertension.
Roy and his colleagues have described their findings as "worrisome" and demanded action to prevent the likely associated increase in the burden of premature cardiovascular diseases.