3. Hypertension control rate in India: systematic review and meta-
analysis of population-level non-interventional studies, 2001–
2022
• The systematic review included 51 studies (n = 338,313 hypertensive patients)
• 21 studies (41%) reported poorer control rates among males than females, and six studies (12%)
reported poorer control rates among rural patients
• The pooled hypertension control rate in India during 2001–2020 was 17.5% with significant increase
over the years, reaching 22.5% in 2016–2020.
• Sub-group analysis showed significantly better control rates in the South and West regions
• Less than one-fourth of hypertensive patients in India had their blood pressure under control
during 2016–2020.
4. South-East Asia India
India Hypertension Control Initiative
• Only about 12% people with hypertension in India have their
blood pressure under control.
• Uncontrolled blood pressure is one of the main risk factors for
cardiovascular diseases (CVDs) such as heart attacks and
stroke, and are responsible for one-third of total deaths in
India.
8. Outline of topics
Lets Understand With a Case Study
Presentation:
• 64-year-Old Male with K/C/O HTN > 14 Years, K/C/O T2DM > 10 Years
• Past (3 Months ago ): BP 160/85 mm Hg
• His blood pressure at his latest clinic visit is 162/90 mm Hg, HR 76 bpm,
RBS 110 mg/dl, Wt – 92 kg, Ht – 6’2, BMI – 26.8 (Overweight)
• Lives alone, occasional drinker, no smoking
• F/H : Father & Mother had HTN
• Already taking – Carvedilol (12.5mg/day) & HCTZ (25mg/day), metformin (500mg/bid)
9. What Is an Appropriate Blood Pressure Target for
This Patient?
12. The blood pressure target for our patient described above is
either <140/90 mm Hg (“reasonable”) or <130/80 mm Hg
may be appropriate
13. J Korean Med Sci. 2020 Dec;35(48):e400.
Proportion of Hypertension-Mediated Organ Damage
14. VOLUME 376, ISSUE 9735, P112-123, JULY 10, 2010
• Hypertension was more
associated with intracerebral
hemorrhage
• Smoking, diabetes,
apolipoproteins, and cardiac
causes were more associated
with ischaemic stroke
15. What Is the Appropriate Antihypertensive
Drug Regimen for This Patient Now?
20. Illustration of Various Drug Class Combinations to Lower Blood
pressure and CV Events
Solid black lines
demonstrates
additive effects
on blood
pressure (BP)
lowering
Orange lines
demonstrate
outcome base
reduction in either
CV events or kidney
disease progression
23. Complementary mechanism of combination antihypertensive therapy with
(ARB) or (DRI), (CCB), and a thiazide diuretic
24. Adherence to Single-Pill
Versus Free-Equivalent
Combination Therapy in
Hypertension
A Systematic Review and Meta-Analysis
Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension
27. Below treatment option will be ideal for our patient for uncontrolled
Hypertension
1. Single Pill, Triple Combination of CCB+ARB+Diuretic will be suitable
• L & T type CCB (Cilnidipine) should be preferred, Looking at efficacy, cardio renal Protection
• In ARBs like Telmisartan is higher treatment compliance and a lower rate of withdrawal due to adverse
events, as compared to ACE inhibitors
• Chlorthalidone, a thiazide-like diuretic, reduces cardiovascular morbidity, such as the incidence of stroke
and heart failure, and cardiovascular mortality
2. Continue Metformin 500 mg bid, Weight reduction is recommended
3. Emphasize on importance of low- Na diet
4. Encourage physical activity, Consider gradual & steady aerobic exercises 3-4x/Week
