60%-70% Indians with hypertension unaware of their condition: Study
India has one of the lowest rates of hypertension diagnosis in the world, a new study published in the peer-reviewed journal The Lancet has shown. Between 60% and 70% of men and women in the country are unaware of their condition. This lack of diagnosis further trickles down to extremely low rates of hypertension treatment leaving people predisposed to life-threatening conditions such as heart attacks and strokes.
Hypertension or high blood pressure is a serious medical condition that can be easily detected at primary health care centres and controlled with low-cost treatment. Yet, India ranked 193rd for women and 170th for men in the rate of hypertension diagnosis among 200 countries, according to the study.
“Low diagnosis was the main reason for India’s low treatment rate,” Dr Bin Zhou, a research fellow at the School of Public Health at Imperial College London, who led the analysis told Hindustan Times in an email. “India’s hypertension treatment rate (35% in women and 25% in men) was about one third lower than the global average (47% in women and 38% in men) and less than half of what the best country achieved (>75%).”
India ranked 160th for women and 143rd for men in the treatment rate. “It means that India’s treatment rate is lower than nearly 80% of all countries,” said Zhou.
An unhealthy diet which includes excessive intake of salt, saturated fat, trans fats, lack of exercise, and obesity are some of the factors linked to hypertension. A family history of hypertension and existing comorbidities such as diabetes and kidney diseases can also put one at risk of high blood pressure.
Hypertension increases the risk of heart, brain, kidney and other diseases. Medical experts said that undetected and untreated hypertension is one of the key reasons for India’s high burden of cardiovascular diseases. Heart disease and stroke contributed to nearly 28.1% of total deaths in India in 2016, according to an earlier Lancet study.
Medical experts in India said that diet played a big role in hypertension prevalence. “Salt intake in India has increased tremendously over the past two decades despite many awareness campaigns linking salt intake to hypertension,” said Dr Rajan Ravichandran, the founder chairman of Chennai based non-profit Sapiens Health Foundation that has been campaigning for lower salt intake. “Consumption of packaged food has gone up over the years. People pay little attention to the hidden salt content in the packaged foods,” he said.
According to Ravichandran, there is also a tendency among Indians to simply link hypertension to stress and avoid medication. “While stress can be a contributing factor, there could be many other reasons for the elevated blood pressure. Avoiding medication can be damaging,” he said calling hypertension a silent killer.
Mumbai based nephrologist Dr Bharat Shah agreed. “Many are not aware of being hypertensive and those who get diagnosed are often inadequately treated,” said Shah. “Hypertension is easy to diagnose and control with medication. But often, people take medication for a few days and stop it abruptly,” he said. Shah advises that everyone should keep a blood pressure machine at home.
The authors of the Lancet study pointed that while nutritional, behavioural, and environmental causes of increased blood pressure are well established, there is little knowledge actions and interventions that can be widely replicated in order to reduce hypertension prevalence. Little transferable guidance exists on how to achieve high rates of detection, treatment, and control for entire populations, the authors state.
Doctors in India, however, root for two crucial policies: mandatory detection of blood pressure during every visit to a doctor and a nationwide salt regulation plan.
“For better diagnosis, we need to first start checking the blood pressure frequently,” said Ravichandran. “Secondly, India needs a salt regulation act in order to reduce salt content in foods. As many as 64 countries now have salt regulating laws and it’s high time for India to have one.”
The hypertension study was conducted by a global network of physicians and researchers with data taken from 1201 studies including 104 million participants in the age group of 30 to 70 years. The study covered the period between 1990–2019. Hypertension was defined as having systolic blood pressure ≥140 millimeters of mercury (mmHg), diastolic blood pressure ≥90 mmHg, and/or taking medication for hypertension.
Globally, the number of adults with hypertension jumped from 650 million to 1.28 billion over the period of 30 years, the study said, adding that the burden had shifted from wealthy nations to low- and middle-income countries. Canada, Peru, Switzerland had among the lowest prevalence of hypertension in 2019. Higher prevalence was seen in countries like Dominican Republic, Jamaica, Paraguay, Hungary among others.
Top 5 countries with the lowest hypertension prevalence in 2019
1. Switzerland, 17%
2. Peru, 18%
3. Canada, 20%
4. Taiwan (Province of China), 21%
5. Spain, 21%
1. Eritrea, 22%
2. Peru, 23%
3. Bangladesh, 24%
4. Canada, 24%
5. Ethiopia, 25%
Top 5 countries with the highest hypertension prevalence in 2019
1. Paraguay , 51%
2. Tuvalu , 51%
3. Dominica , 50%
4. Dominican Republic , 49%
5. Sao Tome and Principe , 48%
1. Paraguay , 62%
2. Hungary , 56%
3. Poland , 55%
4. Argentina , 54%
5. Lithuania , 54%
Top 5 countries with the highest hypertension treatment rate in 2019
1. Republic of Korea, 77%
2. Costa Rica, 76%
3. Kazakhstan, 74%
4. United States of America, 73%
5. Iceland, 72%
1. Canada, 76%
2. Iceland, 71%
3. Republic of Korea, 67%
4. United States of America, 66%
5. Kazakhstan, 66%
Top 5 countries with the lowest hypertension treatment rate in 2019
1. Rwanda, 11%
2. Niger, 15%
3. Kiribati, 15%
4. Ethiopia, 16%
5. Vanuatu, 16%
1. Rwanda, 10%
2. Kenya, 10%
3. Mozambique, 10%
4. Vanuatu, 11%
5. Solomon Islands, 11%