Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey

Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India’s National Family Health Survey Fifth Round (2019–2021). The prevalence of hypertension among 204,054 older adolescents (15–19 years) was 5.08% (95% CI: 4.94–5.23%) wherein 42.26% (95% CI: 40.69–43.64%) were aware of their condition, 43.70% (95% CI: 41.73–45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83–87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.