Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Abstract

AbstractBackgroundHypertension is a significant contributor to mortality in India. Adequate control of hypertension is important to prevent cardiovascular morbidity and mortality.MethodsWe conducted a systematic review and meta-analysis of community-based, non-interventional studies published between 2001 and 2020. We screened records from PubMed, Embase, and Web of Science databases, extracted data, and assessed risk of bias. We conducted random-effects meta-analysis to provide overall summary estimates and subgroup estimates, and mixed-effects meta-regression with sex, region, and study period as covariates. The risk of bias was assessed using modified New Castle-Ottawa scales. This study is registered with PROSPERO, CRD42021267973.ResultsThe systematic review included 37 studies (n=170,631 hypertensive patients). Twelve studies (32%) reported poorer control rates among males than females, four studies (11%) reported poorer control rates among rural patients, while very few studies reported differences across socioeconomic variables. The overall control rate was 33.2% (n=84,485, 95% CI=27.9,38.6) with substantial heterogeneity (I2=99.1%, \chi^2= 3003.91, 95% CI=98.9,99.2; p <0.001). Unadjusted sub-group analysis showed significantly different hypertension control rates across regions (n=12,938, p=0.003) but not across study periods (n= 84,485, p=0.22), or sex (n= 81,197, p=0.22). Meta-regression showed that control rates increased by 14.7% during 2011-2020 compared to 2001-2010 (95%CI=5.8, 23.5, p=0.0021), and was 26.3% higher in the south (95%CI=12.6, 39.9, p=0.0005) and 15.9% higher in the west (95%CI=3.4, 31.4, p=0.0456) compared to the east. The control rates did not differ by sex.ConclusionHypertension is adequately controlled only among one-third of patients in India. The control rate has improved during 2011-2020 compared to 2001-2010, but substantial differences exist across regions. Very few studies examined relevant socioeconomic factors relevant to hypertension control. India needs more studies at the community level to understand the health system and socioeconomic factors that determine uncontrolled hypertension in India.