Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India

• Type of Material: Article
• Authors: Devarsetty Praveen, George Institute for Global Health India; David Peiris, University of New South Wales; Stephen MacMahon, University of New South Wales; Kishor Mogulluru, George Institute for Global Health India; Arvind Raghu, University of Oxford; Anthony Rodgers, University of New South Wales; Shailaja Chilappagari, University of New South Wales; Dorairaj Prabhakaran, Centre for Chronic Disease Control; Gari Clifford, Emory University; Pallab K. Maulik, George Institute for Global Health India; Emily Atkins, University of New South Wales; Rohina Joshi, University of New South Wales; Stephane Heritier, Monash University; Stephen Jan, University of New South Wales; Anushka Patel, University of New South Wales
• Language: English
• Date: 2018-11-15
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-018-6142-x
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 18
• Issue: 1
• Start Page: 1264
• End Page: 1264
• Grant/Funding Information: This study was funded by an Australian National Health and Medical Research Council (NHMRC) Global Alliances for Chronic Disease Grant (ID1040147).; The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; AR is supported by the Wellcome Trust. PM is an Intermediate Career Fellow of The Wellcome Trust/DBT India Alliance.; DPRA is supported by the Australian Agency for International Development (AusAID), DPE is supported by a NHMRC post-doctoral fellowship, and AP and SJ are supported by NHMRC Senior Research Fellowships.; RJ is supported by a National Health Foundation Future Leader Fellowship.
• Keywords: THRESHOLDS; Absolute risk; CORONARY-HEART-DISEASE; India; Life Sciences & Biomedicine; Treatment; Science & Technology; EVENTS; OVERVIEWAND METAANALYSES; Cardiovascular disease; GUIDELINES; Public, Environmental & Occupational Health; Blood pressure; CLINICAL-PRACTICE; PREVENTION; RANDOMIZED-TRIALS; HYPERTENSION; OUTCOME INCIDENCE
• Research Categories: Health Sciences, Public Health

Abstract

Background: Non-optimal blood pressure (BP) levels are a major cause of disease burden globally. We describe current BP and treatment patterns in rural India and compare different approaches to BP lowering in this setting. Methods: All individuals aged ≥40 years from 54 villages in a South Indian district were invited and 62,194 individuals (84%) participated in a cross-sectional study. Individual 10-year absolute cardiovascular disease (CVD) risk was estimated using WHO/ISH charts. Using known effects of treatment, proportions of events that would be averted under different paradigms of BP lowering therapy were estimated. Results: After imputation of pre-treatment BP levels for participants on existing treatment, 76·9% (95% confidence interval, 75.7-78.0%), 5·3% (4.9-5.6%), and 17·8% (16.9-18.8%) of individuals had a 10-year CVD risk defined as low (< 20%), intermediate (20-29%), and high (≥30%, established CVD, or BP > 160/100 mmHg), respectively. Compared to the 19.6% (18.4-20.9%) of adults treated with current practice, a slightly higher or similar proportion would be treated using an intermediate (23·2% (22.0-24.3%)) or high (17·9% (16.9-18.8%) risk threshold for instituting BP lowering therapy and this would avert 87·2% (85.8-88.5%) and 62·7% (60.7-64.6%) more CVD events over ten years, respectively. These strategies were highly cost-effective relative to the current practice. Conclusion: In a rural Indian community, a substantial proportion of the population has elevated CVD risk. The more efficient and cost-effective clinical approach to BP lowering is to base treatment decisions on an estimate of an individual's short-term absolute CVD risk rather than with BP based strategy. Clinical trial registration: Clinical Trials Registry of India CTRI/2013/06/003753, 14 June 2013.