Status of Hypertension Control in Urban Slums of Central India: A community Health Worker-Based Two-Year Follow-Up.

Abhijit Pakhare, Anuja Lahiri, Neelesh Shrivastava, Krishna N Subba, Vaishnavi Veera Durga Kurra, Ankur Joshi, Shubham Atal, Sagar Khadanga, Rajnish Joshi
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Abstract

Background: Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening.

Materials and methods: We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome.

Results: Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure.

Conclusion: We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

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印度中部城市贫民窟高血压控制状况:以社区卫生工作者为基础的两年随访。
背景:高血压(HTN)是导致心血管疾病的主要原因,其控制较差。不同人群亚组的血压控制水平存在异质性。本研究是在印度国家预防和控制癌症、糖尿病、心血管疾病和中风计划(NPCDCS)的框架内进行的。目的是估计最佳血压控制的比例,并确定初始筛查后HTN失控的相关因素。材料和方法:我们在博帕尔16个城市贫民窟群(2017-2018年)的基线筛查中收集了一组HTN患者。在这些贫民窟内培训了16名经认证的社会卫生活动人士。HTN患者与初级保健提供者联系,并在接下来的两年进行随访。结果:在总共6174人中,1571人(25.4%)患有HTN,其中813人以前已知,758人是在基线调查期间新发现的。2年随访1177例(74.9%)。基线时301人(26%)血压得到最佳控制,两年后442人(38%)血压得到最佳控制(绝对增加12%;95% ci 10.2-13.9)。年龄较大、缺乏身体活动、较高的体重指数和新诊断的HTN与不受控制的血压显著相关。结论:我们发现每10例HTN患者中约有6例得到治疗,约4例得到最佳控制。这些发现为NPCDCS在短期随访期间实现的目标提供了基准。
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