Introduction: India faces a high burden of uncontrolled hypertension, which is driving the escalating cardiovascular disease (CVD) epidemic. However, limited information is available on the burden of prehypertension and its risk factors.
Methods: We conducted a representative population based cross-sectional survey among 12243 participants aged ≥30 years residing in epidemiologically transitioning rural and urban areas of North (Haryana) and South (Andhra Pradesh) India, to determine the burden of prehypertension and its risk factors. Participants were selected using a multistage cluster random sampling technique. Data were obtained using an interviewer administered questionnaire, anthropometry and bio-sample collection. Prehypertension and cardiovascular disease (CVD) risk factors were measured using standard protocols and definitions. Age-standardized estimates were calculated using the WHO standard population.
Results: The mean age was 46.8 (SD ±12.5) years and 54% were women. Age-standardized prevalence of prehypertension was 30.7% [95% CI: 29.8-31.6]. The prevalence was higher in men (35.4% [95%CI: 34.1-36.9]) compared to women (26.3% [95%CI: 25.1-27.5]), with not much rural-urban differentials [rural: 29.3% (28.1-30.6), urban: 31.9% (30.6-33.3)]. CVD risk factors such as tobacco and alcohol use, and higher BMI were significantly higher among those with prehypertension compared to normotensives. In the regression analysis, older age (AOR: 2.13 [1.78-2.55]), higher socioeconomic status (AOR: 1.54 [1.30-1.83]), higher BMI (AOR: 1.90 [1.49-2.42]), diabetes (AOR: 1.48 [1.22-1.79]), chronic kidney disease (AOR: 1.35 [1.07-1.71]), and alcohol use (AOR: 1.19 [1.01-1.42]), were associated with higher risk of having prehypertension, while those engaging in physical activity had lower risk (AOR: 0.83 [0.70-0.98]).
Conclusions: In India, a third of the population has prehypertension with narrowing of rural-urban differences, which portend a high future burden of hypertension. Context specific public health measures for risk reduction are imperative along with identification and treatment of those with risk factors by health-care providers.