TY - JOUR
T1 - Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India
AU - Praveen, Devarsetty
AU - Peiris, David
AU - MacMahon, Stephen
AU - Mogulluru, Kishor
AU - Raghu, Arvind
AU - Rodgers, Anthony
AU - Chilappagari, Shailaja
AU - Prabhakaran, Dorairaj
AU - Clifford, Gari D.
AU - Maulik, Pallab K.
AU - Atkins, Emily
AU - Joshi, Rohina
AU - Heritier, Stephane
AU - Jan, Stephen
AU - Patel, Anushka
PY - 2018/11/15
Y1 - 2018/11/15
N2 - 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.
AB - 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.
KW - Absolute risk
KW - Blood pressure
KW - Cardiovascular disease
KW - India
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85056657707&partnerID=8YFLogxK
U2 - 10.1186/s12889-018-6142-x
DO - 10.1186/s12889-018-6142-x
M3 - Article
C2 - 30442122
AN - SCOPUS:85056657707
SN - 1471-2458
VL - 18
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1264
ER -