Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India
<br/><strong>Background: </strong>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.<br/><strong>Methods: <...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BioMed Central
2018
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| _version_ | 1826278217512648704 |
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| author | Praveen, D Peiris, D Macmahon, S Mogulluru, K Raghu, A Rodgers, A Chilappagari, S Prabhakaran, D Clifford, G Maulik, P Atkins, E Joshi, R Heritier, S Jan, S Patel, A |
| author_facet | Praveen, D Peiris, D Macmahon, S Mogulluru, K Raghu, A Rodgers, A Chilappagari, S Prabhakaran, D Clifford, G Maulik, P Atkins, E Joshi, R Heritier, S Jan, S Patel, A |
| author_sort | Praveen, D |
| collection | OXFORD |
| description | <br/><strong>Background: </strong>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.<br/><strong>Methods: </strong>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.<br/><strong>Results: </strong>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.<br/><strong>Conclusion: </strong>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. |
| first_indexed | 2024-03-06T23:40:39Z |
| format | Journal article |
| id | oxford-uuid:6f316452-811c-4885-8eb6-72189c2b443a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:40:39Z |
| publishDate | 2018 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:6f316452-811c-4885-8eb6-72189c2b443a2022-03-26T19:29:10ZCardiovascular disease risk and comparison of different strategies for blood pressure management in rural IndiaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6f316452-811c-4885-8eb6-72189c2b443aEnglishSymplectic Elements at OxfordBioMed Central2018Praveen, DPeiris, DMacmahon, SMogulluru, KRaghu, ARodgers, AChilappagari, SPrabhakaran, DClifford, GMaulik, PAtkins, EJoshi, RHeritier, SJan, SPatel, A<br/><strong>Background: </strong>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.<br/><strong>Methods: </strong>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.<br/><strong>Results: </strong>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.<br/><strong>Conclusion: </strong>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. |
| spellingShingle | Praveen, D Peiris, D Macmahon, S Mogulluru, K Raghu, A Rodgers, A Chilappagari, S Prabhakaran, D Clifford, G Maulik, P Atkins, E Joshi, R Heritier, S Jan, S Patel, A Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title | Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title_full | Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title_fullStr | Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title_full_unstemmed | Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title_short | Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India |
| title_sort | cardiovascular disease risk and comparison of different strategies for blood pressure management in rural india |
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