abstract: 'Author summary Why was this study done? We found only one study that

  reported estimated rates of awareness, treatment, and control (ATC) of

  hypertension in India using a nationally representative sample covering

  all states, but that study was restricted to adults aged 15 to 49 years.

  Another study estimated rates of hypertension ATC among older adults,

  but that study covered only 6 states. This study aimed to provide

  nationally representative estimates of hypertension ATC in the older

  population of India and to describe differences in these indicators of

  hypertension management across sociodemographic groups and states. What

  did the researchers do and find? We used a nationally representative

  sample of adults aged 45 years and over and their spouses covering all

  states (except one) of India in 2017 to 2018. We used measured blood

  pressure (BP) and self-reported diagnosis and treatment for high BP to

  estimate hypertension prevalence and the percentages of those with

  hypertension who were aware of their condition, treated for it, and had

  achieved BP control. We found that a slight majority of those with

  hypertension were aware of their condition, around half were being

  treated, and less than a third had controlled their BP. While these

  rates indicated substantial gaps in hypertension management among the

  older population of India, they were higher than estimates previously

  obtained from samples restricted to, or including, younger people. We

  found substantial variation in the indicators of hypertension management

  across states. Older Indians who were poorer, less educated, socially

  disadvantaged, male, rural, and working were less likely to be aware,

  treated, and to have achieved BP control. What do these findings mean?

  Hypertension prevalence is high in India, particularly in the older

  population. In this critical population group, low rates of ATC point to

  deficiencies in diagnosis and management of the condition and in the

  prevention of cardiovascular diseases (CVDs). Effectively addressing

  these deficiencies requires subtle targeting of interventions that

  balances attention to prevalence, which is higher in the high-income

  states and socioeconomically advantaged groups, with attention to gaps

  in ATC, which are greater in the low- or middle-income states and

  disadvantaged groups.

  Background Lack of nationwide evidence on awareness, treatment, and

  control (ATC) of hypertension among older adults in India impeded

  targeted management of this condition. We aimed to estimate rates of

  hypertension ATC in the older population and to assess differences in

  these rates across sociodemographic groups and states in India. Methods

  and findings We used a nationally representative survey of individuals

  aged 45 years and over and their spouses in all Indian states (except

  one) in 2017 to 2018. We identified hypertension by blood pressure (BP)

  measurement >= 140/90 mm Hg or self-reported diagnosis if also taking

  medication or observing salt/diet restriction to control BP. We

  distinguished those who (i) reported diagnosis ({''''}aware{''''}); (ii)

  reported taking medication or being under salt/diet restriction to

  control BP ({''''}treated{''''}); and (iii) had measured systolic BP <140

  and diastolic BP <90 ({''''}controlled{''''}). We estimated age-sex adjusted

  hypertension prevalence and rates of ATC by consumption quintile,

  education, age, sex, urban-rural, caste, religion, marital status,

  living arrangement, employment status, health insurance, and state. We

  used concentration indices to measure socioeconomic inequalities and

  multivariable logistic regression to estimate fully adjusted differences

  in these outcomes. Study limitations included reliance on BP measurement

  on a single occasion, missing measurements of BP for some participants,

  and lack of data on nonadherence to medication. The 64,427 participants

  in the analysis sample had a median age of 57 years: 58\% were female,

  and 70\% were rural dwellers. We estimated hypertension prevalence to be

  41.9\% (95\% CI 41.0 to 42.9). Among those with hypertension, we

  estimated that 54.4\% (95\% CI 53.1 to 55.7), 50.8\% (95\% CI 49.5 to

  52.0), and 28.8\% (95\% CI 27.4 to 30.1) were aware, treated, and

  controlled, respectively. Across states, adjusted rates of ATC ranged

  from 27.5\% (95\% CI 22.2 to 32.8) to 75.9\% (95\% CI 70.8 to 81.1),

  from 23.8\% (95\% CI 17.6 to 30.1) to 74.9\% (95\% CI 69.8 to 79.9), and

  from 4.6\% (95\% CI 1.1 to 8.1) to 41.9\% (95\% CI 36.8 to 46.9),

  respectively. Age-sex adjusted rates were lower (p < 0.001) in poorer,

  less educated, and socially disadvantaged groups, as well as for males,

  rural residents, and the employed. Among individuals with hypertension,

  the richest fifth were 8.5 percentage points (pp) (95\% CI 5.3 to 11.7;

  p < 0.001), 8.9 pp (95\% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95\% CI

  4.2 to 10.1; p < 0.001) more likely to be aware, treated, and

  controlled, respectively, than the poorest fifth. Conclusions

  Hypertension prevalence was high, and ATC of the condition were low

  among older adults in India. Inequalities in these indicators pointed to

  opportunities to target hypertension management more effectively and

  equitably on socially disadvantaged groups.'
affiliation: 'Mohanty, SK (Corresponding Author), Int Inst Populat Sci, Dept Fertil
  Studies, Mumbai, Maharashtra, India.

  Mohanty, Sanjay K., Int Inst Populat Sci, Dept Fertil Studies, Mumbai, Maharashtra,
  India.

  Pedgaonkar, Sarang P., Int Inst Populat Sci, Dept Populat Policies \& Programmes,
  Mumbai, Maharashtra, India.

  Upadhyay, Ashish Kumar; Shekhar, Prashant; Mishra, Radhe Shyam, Int Inst Populat
  Sci, Mumbai, Maharashtra, India.

  Kampfen, Fabrice, Univ Penn, Populat Studies Ctr, Philadelphia, PA 19104 USA.

  Maurer, Jurgen, Univ Lausanne, Inst Hlth Econ \& Management, Dept Econ, Lausanne,
  Switzerland.

  O''Donnell, Owen, Erasmus Univ, Erasmus Sch Econ, Rotterdam, Netherlands.

  O''Donnell, Owen, Erasmus Univ, Erasmus Sch Hlth Policy \& Management, Rotterdam,
  Netherlands.'
article-number: e1003740
author: Mohanty, Sanjay K. and Pedgaonkar, Sarang P. and Upadhyay, Ashish Kumar and
  Kampfen, Fabrice and Shekhar, Prashant and Mishra, Radhe Shyam and Maurer, Jurgen
  and O'Donnell, Owen
author-email: sanjayiips@yahoo.co.in
author_list:
- family: Mohanty
  given: Sanjay K.
- family: Pedgaonkar
  given: Sarang P.
- family: Upadhyay
  given: Ashish Kumar
- family: Kampfen
  given: Fabrice
- family: Shekhar
  given: Prashant
- family: Mishra
  given: Radhe Shyam
- family: Maurer
  given: Jurgen
- family: O'Donnell
  given: Owen
da: '2023-09-28'
doi: 10.1371/journal.pmed.1003740
eissn: 1549-1676
files: []
issn: 1549-1277
journal: PLOS MEDICINE
keywords-plus: BLOOD-PRESSURE; PREVALENCE; MIDDLE; DISEASE
language: English
month: AUG
number: '8'
number-of-cited-references: '32'
orcid-numbers: 'Mohanty, Sanjay K/0000-0001-9041-5952

  O''Donnell, Owen/0000-0002-6289-1924

  Kampfen, Fabrice/0000-0001-7304-7473

  Upadhyay, Ashish/0000-0003-2518-4603

  /0000-0002-3923-677X

  PEDGAONKAR, SARANG/0000-0002-7570-2037'
papis_id: a3f4b2bdf1f4b2dc5c5a09ffec8b4eb2
ref: Mohanty2021awarenesstreatment
researcherid-numbers: 'Mohanty, Sanjay K/AAR-7658-2020

  pedgaonkar, sarang/HCH-0304-2022

  O''Donnell, Owen/C-1732-2015

  '
times-cited: '23'
title: 'Awareness, treatment, and control of hypertension in adults aged 45 years
  and over and their spouses in India: A nationally representative cross-sectional
  study'
type: Article
unique-id: WOS:000687920900001
usage-count-last-180-days: '1'
usage-count-since-2013: '1'
volume: '18'
web-of-science-categories: Medicine, General \& Internal
year: '2021'