Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

BMC Public Health

Research

Shivani Rao¹  Heena Lalwani¹  Nandini Sharma¹  Mongjam Meghachandra Singh¹  Sandeep Garg²  Saurav Basu³  Vansh Maheshwari³ 

[1] Department of Community Medicine, Maulana Azad Medical College, New Delhi, India;Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India;Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India;

关键词: Hypertension;    Adherence;    Control;    Care cascade;    Screening;    India;   

DOI  :  10.1186/s12889-023-17021-8

 received in 2023-07-20, accepted in 2023-10-19,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India.MethodsThis was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant.ResultsWe included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82).ConclusionsHypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 4