Impact of the 2017 ACC/AHA guidelines on the prevalence of hypertension among Indian adults: Results from a cross-sectional survey

Kartik Gupta; Sivasubramanian Ramakrishnan; Geevar Zachariah; J Shivkumar Rao; P P Mohanan; K Venugopal; Santosh Sateesh; Rishi Sethi; Dharmendra Jain; Neil Bardolei; Kalaivani Mani; Tanya Singh Kakar; Vardhmaan Jain; Prakash Gupta; Rajeev Gupta; Sandeep Bansal; Ranjit K Nath; Sanjay Tyagi; G S Wander; Satish Gupta; Subroto Mandal; Nagendra Boopathy Senguttuvan; Geetha Subramanyam; Debabatra Roy; Sibananda Datta; Kajal Ganguly; S N Routray; S S Mishra; B P Singh; B B Bharti; Mrinal Kanti Das; P K Deb; Prakash Deedwania; Ashok Seth; CSI-Great India BP Campaign Investigators

doi:10.1016/j.ijchy.2020.100055

Impact of the 2017 ACC/AHA guidelines on the prevalence of hypertension among Indian adults: Results from a cross-sectional survey

Int J Cardiol Hypertens. 2020 Oct 7:7:100055. doi: 10.1016/j.ijchy.2020.100055. eCollection 2020 Dec.

Authors

Kartik Gupta^{1

2}, Sivasubramanian Ramakrishnan^{3

4}, Geevar Zachariah⁴, J Shivkumar Rao⁴, P P Mohanan⁴, K Venugopal⁴, Santosh Sateesh⁴, Rishi Sethi⁴, Dharmendra Jain⁴, Neil Bardolei⁴, Kalaivani Mani⁵, Tanya Singh Kakar⁶, Vardhmaan Jain⁷, Prakash Gupta¹, Rajeev Gupta⁴, Sandeep Bansal⁴, Ranjit K Nath⁴, Sanjay Tyagi⁴, G S Wander⁴, Satish Gupta⁴, Subroto Mandal⁴, Nagendra Boopathy Senguttuvan⁴, Geetha Subramanyam⁴, Debabatra Roy⁴, Sibananda Datta⁴, Kajal Ganguly⁴, S N Routray⁴, S S Mishra⁴, B P Singh⁴, B B Bharti⁴, Mrinal Kanti Das⁴, P K Deb⁴, Prakash Deedwania⁸, Ashok Seth⁴; CSI-Great India BP Campaign Investigators

Collaborators

CSI-Great India BP Campaign Investigators:
J Shivkumar Rao, B P Singh, B B Bharti, A K Sinha, Kartik Gupta, Sivasubramanian Ramakrishnan, Sudha Bhushan, Sunil K Verma, Balram Bhargava, Ambuj Roy, Sandeep Bansal, Sanjay Sood, H S Isser, Neeraj Pandit, Ranjit K Nath, Sanjay Tyagi, Vijay Trehan, Mohit D Gupta, M P Girish, Ramandeep Ahuja, S C Manchanda, Arun Mohanty, Peeyush Jain, Sameer Shrivastava, I P S Kalra, B S Sarang, H S Ratti, G Bala Sahib, Rakesh Gupta, S K Agarwal Amit, K C Goswami, V K Bahl, H K Chopra, Ashok Seth, Geevar Zachariah, P P Mohanan, K Venugopal, George Koshy, Tiny Nair, N Shyam, Anil Roby, Raju George, Sudhaya Kumar, Abdul Kader, Mathew Abraham, Sunitha Viswanathan, A Jabir, Jaideep Menon, Govindan Unni, Cibu Mathew, P B Jayagopal, Sajeev, P K Ashokan, Asharaf, Subroto Mandal, A K Pancholia, Neil Bardolei, A K Gupta, Neil Bardolei, Rupam Das, Dinesh Aggarwal, Amit Malviya, S N Routray, S S Mishra, Syed Manzor Ali, Parag Barward, Navreet Singh, Yashbir S Tomar, Davinder Chaddha, Sameer Dani, Chirayu Vyas, Kinjal Bhatt, Shrenik Doshi, G S Wander, Satish Gupta, Chandra Bhan Meena, Santosh Sateesh, Nagendra Boopathy Senguttuvan, Geetha Subramanyam, Subramanyam, Ajit Mullasari Muruganandam, Rishi Sethi, Varun Narain, R K Saran, Dharmendra Jain, Praveen Jain, Sudeep Kumar, P K Goel, Debabatra Roy, Sibananda Datta, Kajal Ganguly, M K Das, Soumitra Kumar, Sarat Chandra, Amal Banerjee, Santanu Guha, P K Deb

Affiliations

¹ Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
² Department of Medicine, Henry Ford Hospital, Detroit, MI, USA.
³ Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
⁴ Cardiology Society of India, India.
⁵ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
⁶ William Beaumont Hospital, Royal Oak, MI, USA.
⁷ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
⁸ School of Medicine, University of California, San Francisco Fresno, CA, USA.

Abstract

Background: The impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown.

Methods: We analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg. We standardized the prevalence as per the 2011 census population of India. We also calculated the prevalence as per the World Health Organization (WHO) World Standard Population (2000-2025).

Results: Among 180,335 participants (33.2% women), the mean age was 40.6 ± 14.9 years (41.1 ± 15.0 and 39.7 ± 14.7 years in men and women, respectively). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%) and 2,878 (1.6%) participants belonged to age group 18-19, 20-44, 45-54, 55-64, 65-74 and ≥ 75 years respectively. The prevalence of hypertension according to the JNC8 and 2017 ACC/AHA guidelines was 29.7% and 63.8%, respectively- an increase of 115%. With the 2011 census population of India, this suggests that currently, 486 million Indian adults have hypertension according to the 2017 ACC/AHA guidelines, an addition of 260 million as compared to the JNC8 guidelines.

Conclusion: According to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension.

Keywords: 2017 ACC/AHA blood Pressure guideline; Health policy; Hypertension; India; Prevalence.