International Journal of Community Medicine and Public Health

Ramu M et al. Int J Community Med Public Health. 2023 Jun;10(6):2219-2223

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Original Research Article

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20231706

Burden of undiagnosed and uncontrolled hypertension and its associated factors among rural populations in South Andaman Islands, India

Manjunatha Ramu*, Ambreen Fatema, S. R. Ghosal, Suma Biji, K. Saida, Alok Mandal

Indian Council of Medical Research (ICMR), Regional Medical Research Centre (RMRC), Port Blair, Andaman and Nicobar Islands, India

Received: 13 April 2023

Accepted: 18 May 2023

*Correspondence:

Dr. Manjunatha Ramu,

E-mail: manjunatha80@yahoo.co.in

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Elevated BP is an important risk factor of cardiovascular diseases; undiagnosed and uncontrolled hypertension is a dangerous situation where target organ damage can occur leading morbidity and mortality in apparently healthy individuals. Therefore, with an aim to study the burden of undiagnosed and uncontrolled hypertension, this study with a cross sectional study design is undertaken in rural areas of South Andaman Islands.

Methods: A community based cross sectional study. A total of 405 participants (Men: 175, Women: 230) were involved, mean age 48.36±15.16 years (Men: 50.69±16.01 years, Women: 46.58±14.26 years).

Results: 30.4% of the participants reported that they are known hypertensives, and out of them only 63.41% were on regular treatment. 17.8% of the participants were first time diagnosed with hypertension during this study. Overall, 48.1% of participants are having hypertension (known hypertensives±newly diagnosed hypertensives), and only 63.20% of them know their status on hypertension. A large proportion are in Pre-hypertension status (52.04%).

Conclusions: Almost half of the population are having burden of hypertension, and nearly 1/3rd of them do not know that they have hypertension; and among those who know the status, only 2/3rd of them are on regular treatment; and a large proportion of population is in pre-hypertension. We need to undertake rigorous efforts to unmask, diagnose and treat hypertension in the community.

Keywords: Andaman, Hypertension, Uncontrolled, Undiagnosed, Rural

INTRODUCTION

Elevated BP is an important risk factor of cardiovascular diseases. Undiagnosed and uncontrolled hypertension is a dangerous situation where target organ damage can occur leading morbidity and mortality in apparently healthy individuals. In 1999, according to a study conducted by Gupta R., by title, “Hypertension in India-definition, prevalence and evaluation” it was shown that the prevalence of hypertension with high Blood pressure in general population was 1.1% to 5.7%.1 According to NFHS-5, 24% of men aged 15 and over and 21% of women aged 15 and over are having hypertension i.e., a massive increase of 20% in prevalence over two decades and shows that it is essential to understand the pattern and risk factors for hypertension, which is an important risk factor for cardiovascular diseases. In Andaman and Nicobar Islands elevated BP prevalence with 30.2% among men and 25.3% among women is an alarming situation to the health system.2

Global burden of diseases study estimated that hypertension led to 1.63 million deaths in India in 2016 as compared to 0.78 million in 1990 (+108%). The disease burden (DALYs) attributable to hypertension increased from 21 million in 1990 to 39 million in 2016 (+89%), these evidences suggest that hypertension is a growing public health burden in Indian population.8

Andaman and Nicobar Islands are Union Territory of India consisting of 836 Islands/Islets/Rocky Outcrops, of which 38 are inhabited, these Islands are unique as they are situated in the South-Eastern part of Bay of Bengal and around 1200 km away in the ocean from the mainland of India.13 Healthcare delivery for these Islands is of challenging nature because of the rural and remote nature of the geographical locations of these Islands.

Therefore, to study the burden of undiagnosed and uncontrolled hypertension, this study is undertaken in rural areas of South Andaman Islands.

METHODS

A community based cross-sectional study was conducted in rural areas of South Andaman Islands between October 2021 to February 2023, sample size was calculated by using the formula for estimation of proportion for one sample situation to detect prevalence of 24.95% of Hypertension among adults, the minimum sample size required was 376 with allowable error of 5% and design effect of 1.3, however a total of 405 individuals participated in the study.2 Adults aged ≥18 years, living in rural areas of South Andaman Islands were included in the study.

Out of 99 revenue villages in the South Andaman District, 11 villages were selected in consultation with the Gram Panchayats, and in these villages, consecutive house to house visits were carried out by front line health functionaries, and adults aged ≥18 years who were willing to provide informed consent and participate in the study from those localities were mobilized for the study, a team of trained experts conducted interviews and recorded necessary information at a central location in these villages. Seriously ill and bed ridden individuals were excluded from the study. Written informed consent was obtained from the participants and data was collected using a predesigned, pretested, structured, modified version of WHO STEPS surveillance questionnaire. Ethical approval was taken from Institutional Human Ethics Committee of ICMR – Regional Medical Research Centre, Port Blair.

RESULTS

A total of 405 participants (Men: 175, Women: 230) were involved, mean age 48.36±15.16 years (Men: 50.69±16.01 years, Women: 46.58±14.26 years). Sociodemographic profile of the participants are shown in Table 1.

A total 30.4% of the participants reported that they are known hypertensives, and out of them only 63.41% were on regular treatment and remaining were irregular with treatment despite of being aware of their hypertension status. 17.8% of the participants were first time diagnosed with hypertension during the study. Overall, 48.1% of participants are having hypertension (Known hypertensives + Newly diagnosed hypertensives), and only 63.20% of them know their status on hypertension, and nearly 1/3rd of them do not know that they have hypertension, among remaining individuals, a large proportion are in Pre-hypertension status (52.04%).

Table 1: Socio - demographic profile of participants.
Table reproduced from source PDF page 2

Being an elderly person, being a Christian compared with other religions, being an illiterate/having lower educational status, separated or divorced in marital status, using smokeless tobacco and being a person of overweight or obese are having higher chances of having hypertension. In binary logistic regression with all above factors, it was found that being a person with elderly age (P<0.01) and being overweight or obese (P<0.01) are the factors associated with hypertension.

Figure 1: Status of hypertension and pre-hypertension in the community. | Normotensives 29% Pre- hypertensi on 31% Stage 01 Hypertens ion 23% Stage 02 Hypertens ion 17%
Figure 1: Status of hypertension and pre-hypertension in the community.
Figure 2: Status of hypertension care in the community. | 0 20 40 60 80 100 100 % 48.1% 30.4% 19.3% On regular treatment Known the status Overall Hypertensives Total population
Figure 2: Status of hypertension care in the community.
Table 2: Results of binary logistic regression analysis.
Table reproduced from source PDF page 3

DISCUSSION

In 2019, a National level survey was conducted across 24 States, in which blood pressure was recorded for 180,335 participants and overall prevalence of hypertension was 30.7%, but proportion of hypertensives reported is high in our study.3 Mohanty et al, conducted a study on “Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A Nationally representative cross-sectional study”, hypertension prevalence was estimated to be 41.9% and awareness, treatment and control of hypertension were low among older adults in India.4

In 2020, random-effects meta-analysis was used to pool the prevalence estimates and to perform subgroup analyses to estimate the prevalence of hypertension in Bangladesh, and it was found out that, prevalence of hypertension was high and rising, literature evidences have shown in India that prevalence of hypertension is on the rise in Indian population.1,2,5,8

Mukherjee et al, conducted a study on “prevalence of obesity and hypertension among the adult Bhantus of Andaman, India: a preliminary study”, in their study, prevalence of general obesity was found out to be 40.7% and that of hypertension as 26.6%.6 It was also shown that there was a positively significant age effect on both obesity and hypertension, in our study focussing on South Andaman Islands, we have estimated that 59.4% are overweight / obese and a higher proportion of population are having problems of hypertension, and there is a significant association between overweight and obesity with hypertension.

Hazarika et al, did a report of the systematic review and meta-analysis of the literature on the prevalence of hypertension among Indian tribes by following the PRISMA guidelines. The studies covered tribal populations in different regions of India. The pooled prevalence of hypertension among men, and women were 23.66%, and 23.37% respectively and it was found that the prevalence is rising.7

According to the study conducted by Manimunda et al, on "Association of hypertension with risk factors and hypertension related behaviour among the aboriginal Nicobaresse tribe living in Car Nicobar Island, India"; the prevalence of hypertension was 50.5%. The prevalence of tobacco, alcohol consumption, and obesity was 88, 54, and 37 per cent respectively. The association was found between prevalence of hypertension and prevalence of tobacco, alcohol consumption, and obesity. The prevalence of hypertension among Nicobarese was high and was much more than the rural and urban populations in India.9 In our study we have estimated almost similar burden of hypertension, overweight and obesity among rural population in South Andaman Islands.

CONCLUSION

Almost half of the population are having burden of hypertension, and nearly 1/3rd of them do not know that they have hypertension; and among those who know the status, only 2/3rd of them are on regular treatment; and a large proportion of population is in pre-hypertension; this indicates that elevated blood pressure is a major public health problem in South Andaman, and diagnosed hypertensives are representing only a tip of the ice berg, and a large portion of the burden is not visible; therefore, we need to undertake rigorous efforts to unmask, diagnose and treat hypertension in the community.

ACKNOWLEDGEMENTS

The authors are thankful for the research team at ICMR - RMRC, Port Blair and front-line health workers of South Andaman who mobilized participants to this study.

Funding: Intramural funds from ICMR – Regional Medical Research Centre, Port Blair

Conflict of interest: None declared

Ethical approval: Ethical approved obtained from Institutional Human Ethics Committee (IHEC), ICMR – RMRC, Port Blair

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