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Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 269-275

Is the rule of halves in hypertension valid uniformly across India? A cross-sectional analysis of national family health survey-4 data

1 Assistant Professor, Department of Community Medicine, Rani Durgavati Medical College, Banda, Uttar Pradesh, India
2 Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
3 Senior Operational Research Fellow, Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
4 Public Health Masters Program, School of Medicine, University of Limerick, Limerick, Ireland
5 Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Sonu Goel
Professor of Health Management, Department of Community Medicine and School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh; Adjunct Clinical Associate Professor, Public Health Masters Program School of Medicine and Health Research Institute (HRI), University of Limerick
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_2143_21

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Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey-4 was conducted. We included 770,662 individuals (112,122 men and 658,540 nonpregnant women) of 15–49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%–49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%–72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%–40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three-fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.

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