Publication:

Rising hypertension and post-COVID cardiovascular risk among rural women in Punjab: implications for community-based screening and surveillance

Background Hypertension is the foremost modifiable cardiovascular risk factor globally and constitutes a growing non-communicable disease (NCD) burden in rural India. The COVID-19 pandemic has introduced an additional layer of complexity to hypertension epidemiology.

Methods A community-based cross-sectional study was conducted among 2,160 adult women aged 18-69 years residing in rural Punjab. Participants were recruited through multistage stratified cluster sampling, with data collection guided by the WHO STEPwise approach to Non-Communicable Disease Risk Factor Surveillance (STEPS). Blood pressure was measured using standardised protocols and JNC VIII guidelines.

Results Among the 2,160 participants, more than one-third (38.3%, n=827) were found to be hypertensive, comprising 27.9% with Stage 1 and 10.4% with Stage 2 hypertension, while an additional 31.1% were classified as pre-hypertensive. Significant associations were identified between hypertension and older age (45-69 years: 66.1%), married marital status (90.7%), illiteracy (64.6%), labourer occupation (71.0%), lower socioeconomic class (45.9%), and overweight or obese BMI (≥23 kg/m²). While a prior history of COVID-19 infection did not independently predict hypertension status (χ²=0.411, p=0.524), the occurrence of blood pressure fluctuations during or following COVID-19 illness and the presence of pre-existing comorbidities before COVID-19 infection were both strongly and significantly associated with hypertension.

Conclusions Rural women in Punjab carry a substantial and largely underdiagnosed burden of hypertension, with 38.3% prevalence and an additional 31.1% at the pre-hypertensive threshold. These findings underscore the urgent need for systematic community-based blood pressure screening, gender-sensitive preventive interventions, and dedicated post-COVID cardiovascular surveillance to reduce long-term cardiovascular morbidity in this vulnerable population.