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

Autor: Praveen D; The George Institute for Global Health, Hyderabad, India. dpraveen@georgeinstitute.org.in.; University of New South Wales, Sydney, Australia. dpraveen@georgeinstitute.org.in., Peiris D; The George Institute for Global Health, University of New South Wales, Sydney, Australia., MacMahon S; The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Mogulluru K; The George Institute for Global Health, Hyderabad, India., Raghu A; Institute of Biomedical Engineering, University of Oxford, Oxford, UK., Rodgers A; The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Chilappagari S; The George Institute for Global Health, University of New South Wales, Sydney, Australia., Prabhakaran D; Centre for Chronic Disease Control, New Delhi, India.; London School of Hygiene and Tropical Medicine, London, UK., Clifford GD; Department of Biomedical Informatics, Emory University, Atlanta, GA, USA.; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA., Maulik PK; The George Institute for Global Health, Delhi, India., Atkins E; The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Joshi R; The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Heritier S; Monash University, Melbourne, Australia., Jan S; The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Patel A; The George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2018 Nov 15; Vol. 18 (1), pp. 1264. Date of Electronic Publication: 2018 Nov 15.
DOI: 10.1186/s12889-018-6142-x
Abstrakt: 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.
Databáze: MEDLINE
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