Hypertension Diagnosis, Treatment, and Control in India.
Hypertension Diagnosis, Treatment, and Control in India.
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DOI：
10.1001/jamanetworkopen.2023.39098
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发表时间：
2023-10-02
影响因子：
13.8
通讯作者：
Ali, Mohammed K.
中科院分区：
文献类型：
--
作者：
Varghese, Jithin Sam;Venkateshmurthy, Nikhil Srinivasapura;Sudharsanan, Nikkil;Jeemon, Panniyammakal;Patel, Shivani A.;Thirumurthy, Harsha;Roy, Ambuj;Tandon, Nikhil;Narayan, K. M. Venkat;Prabhakaran, Dorairaj;Ali, Mohammed K.
在印度，高血压护理连续体(诊断、治疗和控制)的差距是什么？在印度，这些差距是如何因邦、地区和社会人口群体而变化的？在这项针对170万名受访者的2019-2021年全国调查研究中，28.1%的人患有高血压，其中36.9%的人得到了诊断；44.7%的确诊者(占高血压患者总数的17.7%)报告服用药物，52.5%的治疗者(占高血压患者总数的8.5%)实现了血压控制。高血压护理连续体中的大部分变异性是在状态内观察到的，而不是在状态之间观察到的。这项研究表明，各邦之间和地区之间的差异表明，需要有针对性的、分散的解决方案来改善印度的高血压护理连续体。高血压是世界范围内发病率和死亡率的主要原因。在印度，以前研究高血压护理连续体的差距--包括诊断、治疗和控制--的努力没有评估地区水平的差异。当地数据对于计划、实施和监测遏制高血压负担的努力至关重要。调查印度18至98岁人群中的高血压护理连续体。具有全国代表性的第五次全国家庭健康调查研究从2019年6月17日至2020年3月21日和2020年11月21日至2021年4月30日分两个阶段在印度28个邦、8个联邦地区和707个区的1 895 297个人中进行。地区和居住状态、城市分类、年龄(18-39岁、40-和≥65岁)、性别和家庭财富五分之一。高血压被定义为自我报告的诊断或新测量的血压为140/90毫米汞柱或更高。根据国家指南计算确诊(自我报告)的个人比例、确诊患者中接受治疗的个人比例(自我报告用药情况)以及接受治疗的患者中血压得到控制的个人比例(血压和lt；140/90 mm Hg[18-79岁]或150/90 mm Hg[老年≥80岁])。在高血压患者总数中也提供了治疗和控制的年龄标准化估计。为了评估州之间或州内(即地区之间)护理连续体的差异，使用广义线性混合模型对方差进行划分。在1名 691 036名成年受访者(52.6%女性，平均年龄41.6[16.5]岁)中，28.1%(95%CI，27.9%-28.3%)有高血压，其中36.9%(95%CI，36.4%-37.3%)确诊。在确诊的高血压患者中，有44.7%(95%可信区间，44.1%~45.3%)的患者曾服药(占高血压患者总数的17.7%[95%可信区间，17.5%~17.9%])。在接受治疗的患者中，52.5%(95%可信区间，51.7%~53.4%)的患者血压得到了控制(相当于高血压患者总数的8.5%[95%可信区间，8.3%~8.6%])。不同地区在血压诊断(范围6.3%-77.5%)、治疗(范围8.7%-97.1%)和控制(范围2.7%-76.6%)方面存在很大差异。高血压诊断(94.7%)、治疗(93.6%)和对照(97.3%)的大部分差异在州内，而不仅仅是州之间。在这项针对印度成年人的横断面调查研究中，超过四分之一的人患有高血压，其中只有三分之一的人得到了诊断，不到五分之一的人得到了治疗，只有十二分之一的人血压得到了控制。国家平均值掩盖了国家和地区一级护理连续体中相当大的差异，这表明需要有针对性的分散解决方案来改善印度的高血压护理连续体。这项具有全国代表性的调查研究考察了印度18至98岁人群的高血压护理连续体--包括诊断、治疗和控制。
What are the gaps in the hypertension care continuum (diagnosis, treatment, and control), and how do they vary by state, district, and sociodemographic groups in India? In this 2019-2021 national survey study of 1.7 million respondents, 28.1% had hypertension, of whom 36.9% received a diagnosis; 44.7% of those who received a diagnosis (17.7% of the total with hypertension) reported taking medication, and 52.5% of those treated (8.5% of the total with hypertension) achieved blood pressure control. Most of the variability in the hypertension care continuum was observed within, not between, states. This study suggests that differences between states and between districts in states indicate the need for targeted, decentralized solutions to improve the hypertension care continuum in India. Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum—including diagnosis, treatment, and control—in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hypertension. To examine the hypertension care continuum in India among individuals aged 18 to 98 years. The nationally representative Fifth National Family Health Survey study was conducted in 2 phases from June 17, 2019, to March 21, 2020, and from November 21, 2020, to April 30, 2021, among 1 895 297 individuals in 28 states, 8 union territories, and 707 districts of India. District and state of residence, urban classification, age (18-39, 40-64, and ≥65 years), sex, and household wealth quintile. Hypertension was defined as a self-reported diagnosis or a newly measured blood pressure of 140/90 mm Hg or more. The proportion of individuals diagnosed (self-reported), the proportion of individuals treated among those diagnosed (self-reported medication use), and the proportion of individuals with blood pressure control among those treated (blood pressure <140/90 mm Hg [aged 18-79 years] or <150/90 mm Hg [aged ≥80 years]) were calculated based on national guidelines. Age-standardized estimates of treatment and control were also provided among the total with hypertension. To assess differences in the care continuum between or within states (ie, between districts), the variance was partitioned using generalized linear mixed models. Of the 1 691 036 adult respondents (52.6% women; mean [SD] age, 41.6 [16.5] years), 28.1% (95% CI, 27.9%-28.3%) had hypertension, of whom 36.9% (95% CI, 36.4%-37.3%) received a diagnosis. Among those who received a diagnosis, 44.7% (95% CI, 44.1%-45.3%) reported taking medication (corresponding to 17.7% [95% CI, 17.5%-17.9%] of the total with hypertension). Among those treated, 52.5% (95% CI, 51.7%-53.4%) had blood pressure control (corresponding to 8.5% [95% CI, 8.3%-8.6%] of the total with hypertension). There were substantial variations across districts in blood pressure diagnosis (range, 6.3%-77.5%), treatment (range, 8.7%-97.1%), and control (range, 2.7%-76.6%). Large proportions of the variation in hypertension diagnosis (94.7%), treatment (93.6%), and control (97.3%) were within states, not just between states. In this cross-sectional survey study of Indian adults, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control. National mean values hide considerable state-level and district-level variation in the care continuum, suggesting the need for targeted, decentralized solutions to improve the hypertension care continuum in India. This nationally representative survey study examines the hypertension care continuum—including diagnosis, treatment, and control—in India among individuals aged 18 to 98 years.
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DOI：
10.1161/hypertensionaha.118.11609
发表时间：
2018-09
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
--
作者：
Lamprea-Montealegre JA;Zelnick LR;Hall YN;Bansal N;de Boer IH
通讯作者：
de Boer IH
影响因子：
4.1
作者：
Kothavale A;Puri P;Sangani PG
通讯作者：
Sangani PG
影响因子：
15.8
作者：
Lee J;Wilkens J;Meijer E;Sekher TV;Bloom DE;Hu P
通讯作者：
Hu P
影响因子：
39
作者：
Geldsetzer, Pascal;Manne-Goehler, Jennifer;Atun, Rifat
通讯作者：
Atun, Rifat
影响因子：
1.3
作者：
Barnett, Adrian G.;Sans, Susana;Dobson, Annette J.
通讯作者：
Dobson, Annette J.