Variations in the hypertension care cascade across districts and the factors influencing it among Indian adults: findings from the National Family Health Survey -5

Abstract

Hypertension, a leading cause of cardiovascular diseases, accounts for 7.5 million deaths annually, affecting over 1.3 billion people globally, with significant burdens in low- and middle-income countries like India. It significantly impacts India's population, with low rates of awareness, diagnosis, and treatment. This study examines the hypertension care cascade and its key determinants at the national, state, and district levels in India. The analysis was conducted using data from the NFHS-5 survey, involving a total of 743,067 adults aged 18-54 years. From this group, 118,231 individuals with hypertension were identified, and the hypertension care cascade was constructed. A color-coded map was generated to visually depict geographic disparities in prevalence rates across different regions of India. Multivariate logistic regression was employed at the district, state, and national levels, with significance set at p < 0.05. Hypertension awareness varied significantly across districts, with an average rate of 46.0%, ranging from 89.6-6.1%. Treatment rates were 18.7%, with considerable disparity among districts. Blood pressure control was achieved in 32.9% of individuals with hypertension. Older age, female gender, higher socioeconomic status, urban residence, and obesity were associated with better attainment of cascade steps. Conversely, younger age and alcohol consumption were linked to lower attainment, while educated individuals showed lower treatment-seeking behavior despite better awareness. Poor-performing districts were identified in Gujarat, Chhattisgarh, and Madhya Pradesh. These findings highlight the need for targeted, evidence-based interventions to address regional disparities, enhance hypertension care, and reduce the cardiovascular disease burden in India.