Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension

Abstract

Background: A region-specific (urban and rural parts of north, east, west, and south India) systematic review and meta-analysis of the prevalence, awareness, and control of hypertension among Indian patients have not been done before.

Methods: Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for 'prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) among Indian adults' (≥18 years). Of the total 3047 articles, 142 were included.

Results: Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7-33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2-32.0) and 33.8% (29.7-37.8); P = 0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3-15.7), 31.7% (30.2-33.3), 18.1% (16.9-19.2), and 21.1% (20.1-22.0) for rural north, east, west, and south India; and 28.8% (26.9-30.8), 34.5% (32.6-36.5), 35.8% (35.2-36.5), and 31.8% (30.4-33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4-29.3), 25.1% (17.0-33.1), and 10.7% (6.5-15.0) for rural Indians; and 42.0% (35.2-48.9), 37.6% (24.0-51.2), and 20.2% (11.6-28.7) for urban Indians.

Conclusion: About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.

FIGURE 1

Flow diagram for selection of studies.

FIGURE 2

Overall pooled estimates: region-wise (north, east, west, and south) and place-wise (rural and urban). P value for overall rural and urban differences in hypertension (HTN) prevalence = 0.05^∗; P value for rural and urban differences in HTN prevalence for east India = 0.98; P value for rural and urban differences in HTN prevalence for north India = 0.07; P value for rural and urban differences in HTN prevalence for south India = 0.62; P value for rural and urban differences in HTN prevalence for west India = 0.05^∗. CI, confidence interval. ^∗Statistically significant.

FIGURE 3

Percentage aware, treated, and under control for hypertension (HTN): urban and rural areas. P value for overall rural and urban differences in awareness of hypertension = 0.002^∗; P value for rural and urban differences in HTN treatment = 0.112; P value for rural and urban differences in HTN control = 0.03^∗. BP, blood pressure; CI, confidence interval; ES, pooled estimate; ^∗Statistically significant.