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

Devarsetty Praveen, David Peiris, Stephen MacMahon, Kishor Mogulluru, Arvind Raghu, Anthony Rodgers, Shailaja Chilappagari, Dorairaj Prabhakaran, Gari D. Clifford, Pallab K. Maulik, Emily Atkins, Rohina Joshi, Stephane Heritier, Stephen Jan, Anushka Patel

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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.

Original languageEnglish
Article number1264
Number of pages11
JournalBMC Public Health
Issue number1
Publication statusPublished - 15 Nov 2018


  • Absolute risk
  • Blood pressure
  • Cardiovascular disease
  • India
  • Treatment

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