Patient compliance, comorbidities, and challenges in the management of hypertension in India

Abstract

Background and Objectives: As of now, only one-third of those with hypertension in India are unaware of the existence of this condition, and only a negligible share of those diagnosed can control it through medication. There is a need to understand the characteristics and behaviors of patients treated for hypertension for generating evidence for better management of this condition. In this context, the study examines the key factors associated with uncontrolled blood pressure (BP) levels in patients under medication for hypertension. Subject and Methods: Data from the nationally representative Longitudinal Ageing Study of India survey, 2017–18, are used for the analysis. This study is restricted to 12,353 respondents aged 45 years and above who were already diagnosed with hypertension before the survey and are under medication. BP level at the point of the survey was used to classify the respondents as hypertension under control (systolic <140 mm and diastolic <90 mm), Grade-1 Hypertension (systolic 14–159 mm or diastolic 90–99 mm), Grade-2 Hypertension (systolic160–179 mm or diastolic 100–109 mm), and Grade-3 Hypertension (systolic 180 or above mm or diastolic 110 or above mm). Bivariate and multivariate logistic regression analysis is performed to study the association between hypertension control in these patients and their demographic, socioeconomic, and behavioural characteristics. Results: A critical proportion of respondents have uncontrolled hypertension of Grade 1 (31%), Grade 2 (15%), and Grade 3 (2%), despite taking medication for the same. As compared to their remaining counterparts, the risk of uncontrolled hypertension is high in rural areas (odds ratio [OR] = 1.37, 95% confidence interval [CI], P < 0.01), old-adults living alone (OR = 1.63, 95% CI, P < 0.05), patients having no schooling (OR = 1.18, 95% CI, P < 0.05), patients with obesity (OR = 1.2, 95% CI, P < 0.05), moderate alcohol drinkers (OR = 2.1, 95%CI, P < 0.01), abusive alcohol drinkers (OR = 1.6, 95% CI, P < 0.01). Interpretation and Conclusions: Poor control over BP levels among patients from rural areas, the poorest and most vulnerable sections, supports the governmental efforts initiated since 2018 to expand community-level screening and provisioning of noncommunicable diseases, including that for hypertension. In addition, concrete efforts for health promotion within patients under medication for hypertension too are essential for better management of this condition.