Household Aggregation of Hypertension in India: A Cross-Sectional Study of Nationally Representative Data From 450...

Over 315 million adults live with hypertension in India, of whom only 37% are diagnosed. In addition to community-based screening, targeting high-risk households may identify undiagnosed individuals. We estimated the magnitude of household aggregation of diagnosed and undiagnosed hypertension among co-residing adults and evaluated whether household members offer pathways for novel screening and management strategies.

The overall sample consisted of 450 520 households with 1 407 886 adult participants (18-99 years old) of the Indian National Family Health Survey-5, 2019 to 2021. Household aggregation was defined as ≥2 co-residing members of a household having hypertension (self-reported as physician diagnosed, or measured systolic blood pressure ≥140, or diastolic blood pressure ≥90 mm Hg). Among the analytic sample (mean age, 32.5 years; 53.2% women), 25.8% had hypertension, and 48.4% of respondents had ≥1 other members in the household with hypertension. Individuals with diagnosed (prevalence ratio [PR], 2.49 [95% CI, 2.44-2.54]) and undiagnosed hypertension (PR, 1.16 [95% CI, 1.15-1.17]) were more likely to cluster with others of the same status. Exploratory analyses suggest that the number of households to be screened to identify 1 new case of undiagnosed hypertension was lowest for households with a newly detected (ie, previously undiagnosed) individual with hypertension, followed by households of individuals with normal blood pressure and diagnosed hypertension, respectively.

Our study provides novel evidence about aggregation of hypertension among Indian households. Given the high burden of hypertension in India, household-focused screening and management interventions can augment current strategies for closing the gaps in hypertension diagnosis and control.