When it comes to hypertension prevalence, rural India is not far behind its urban counterpart. A large-scale study undertaken recently in rural Tamil Nadu has confirmed the high prevalence.
A study published in the International Journal of Public Health reported 21.4 per cent hypertension prevalence in about 10,500 people (aged 25-64) in 11 villages in the State. Prevalence was nearly the same in both sexes.
Though earlier studies had documented 16 per cent prevalence in rural areas, studies carried out later in other States had reported 20 per cent prevalence. Prevalence of hypertension in urban areas is 22-30 per cent. The latest study gains importance as there is very little data on prevalence of hypertension in rural Tamil Nadu.
If the higher prevalence in rural population is bad enough, a large percentage of people remaining ignorant of their condition is indeed a major cause for concern. “About 75 per cent of people with hypertension were ignorant of their condition,” said Dr. Prabhdeep Kaur, the first author of the study and a Scientist at the National Institute of Epidemiology, Chennai. “It [ignorance] was more in the younger age group.” This is one of the major findings of the study.
Unlike older people who may become aware of their hypertension status when visiting healthcare facilities for other conditions, younger people are less likely to suffer from major illnesses and hence less likely to visit doctors. “Doctors too don’t expect younger people to be hypertensive and suffer from lifestyle diseases,” she said.
The proportion of people (both males and females) whose hypertensive status was newly diagnosed decreased with age and awareness of the condition.
Hypertension is one of the major risk factors for cardiovascular diseases, stroke and kidney failure. According to the paper, about 24.5 per cent of deaths in people aged 45-59 years in rural Tamil Nadu are caused by diseases of the circulatory system.
If being aware of their status was low, percentage of people who were on treatment was just 20 per cent. Even more shocking is the fact that a mere 6.6 per cent of people on treatment had their blood pressure under control. “Control rates were low among both males and females in all age groups,” notes the paper. “This study indicated hypertension is an emerging public health problem in rural population in …Tamil Nadu.”
People were classified as suffering from hypertension if their systolic blood pressure was above 140 mmHg or diastolic blood pressure was above 90 mmHg or when both systolic and diastolic blood pressures were above normal. The World Health Organisation (WHO) criteria were used to classify people as Type I, Type II or Type III.
About 71 per cent of people had Type I hypertension (where the systolic blood pressure and/or diastolic blood pressure is above 140 mmHg and above 90 mmHg respectively). At 20.3 per cent, Type II -- where the systolic blood pressure is between 160-179 mmHg and/or diastolic blood pressure is between 100-109 mmHg -- came second.
A significant population had only systolic (nearly 29 per cent) or diastolic (31 per cent) blood pressure above normal. “Older people tend to have isolated systolic hypertension, and isolated diastolic hypertension is more prevalent in younger people,” Dr. Kaur said.
If central obesity (a big paunch) and body mass index (BMI) of more than 23 were found to be positively related to hypertension, alcohol as a risk factor for hypertension was too very apparent.
“Alcohol emerged as an important risk factor among males,” the paper notes. “Public health policy interventions for alcohol are difficult to implement due to dependency of the government on revenue from alcohol in many developing countries including India. This is also true for Tamil Nadu where government is the sole distributor of alcohol and had significant revenue from alcohol.”
The authors stress that there is an urgent need to target the high risk groups, particularly those who consume alcohol. High prevalence, low awareness, low treatment rates, and poor control among those under treatment in the rural areas make hypertension an “emerging public health challenge” that can increase the rates of mortality and morbidity from cardiovascular diseases.
TN starts screening, treating people with hypertension
Tamil Nadu has started a new project this year to screen and treat people for hypertension. It started with a pilot project in Sivaganga and Virudhunagar districts during 2007-2010. About 11,31,000 people were screened for hypertension in 98 health facilities during the pilot project.
The Tamil Nadu Health Systems Project (TNHSP) has scaled up the pilot project in 16 districts. “This year we have been implementing the Phase I of the programme to screen and treat people with hypertension in 16 districts,” said Dr. Jerard M. Selvam, Deputy Director, Non-communicable diseases, TNHSP, Chennai. “Preparatory activities, including training, are underway in the remaining 16 Phase II districts.”
“Positively, by March-April 2013, the remaining 16 Phase II districts will also be implementing the project,” he stressed. With that the entire State will be covered.
According to him, in the third quarter alone (July to September 2012), 8,57,616 people who came to healthcare facilities (in the 16 districts) for other ailments were screened. Of these, 60,517 were found to have hypertension. The percentage of people testing positive for hypertension was 7.06 per cent.
Providing treatment to people detected under this project runs concurrently with the existing programme that provides treatment for people with hypertension.