Unraveling the Spectrum of Hypertension among Adult Women in an Urban Area of North India through Level of Prevention-based Color-coded Stratification

ABSTRACT IMAGE

INTRODUCTION

The prevalence of cardiovascular diseases (CVDs) such as hypertension (HTN), atherosclerosis, stroke, and myocardial infarction increases with age in both men and women.^[1] It exerts a substantial public health burden on healthcare systems, as it is responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.^[2]

According to the WHO, one of the major global causes of premature death is high blood pressure.^[3] Only 10–25 % of Indian HTN population have their blood pressure (BP) under control.^[4] The low awareness and treatment levels among hypertensive patients signify poor knowledge, attitude, and practice levels among patients. The current mass-level strategies to control BP among Indian HTN patients are not working. These findings have enormous public health significance for policymakers and physicians alike.

There is a need to foster a conducive communication ambiance to convince HTN patients to take the treatment prescribed by the concerned physician.

At the grassroots level, there is a need to adopt a simple approach, which a primary health care worker can use comfortably. A color-coded client segmentation approach can be useful for HTN control in a community setting. Easy interface and color codes are recognized not only by the health care professionals but also by the caretakers irrespective of their educational status.

Risk profiling of HTN patients can be facilitated by color-coded health cards using standard risk prediction charts. Their language needs to be easy for better understanding by the patients. Such an approach will help in planning appropriate management.^[5-10] This will help in averting cardiovascular deaths.

This will also be in tandem with the current focus of healthcare providers on an individualized patient-centered approach.

The color-coded approach has been in use in our health system for long. This system has been useful in many ways.

The use of such a color coding system in chronic diseases has tremendous potential for ensuring good quality health service delivery, especially in poor resource settings where chronic disease burden is high.

MATERIALS AND METHODS

This was a cross-sectional study conducted during June–July 2023 at UHTC of a private medical college. The sample size was calculated as 256 (n = 4PQ/d²).

A level of prevention-based color-coded stratification was done by the principal investigator (PI) for patient segmentation.

RESULTS

The majority of respondents were married (75.4%). Their literacy rate was 72% [Table 1]. The majority of the respondents were homemakers (58.2%). The mean age of the respondents was 38.23 years, (range 18–75 years).

Monthly household income ranged from Rs. 1,000 to 60,000, with a mean of Rs. 10,611.72. The average family size was 4.61 members.

Overall, 39.07% of the respondents reported being diagnosed with HTN, with 31% of them having been diagnosed for less than a year, 27% for 1–5 years, 23% for 5–10 years, and 19% for over 10 years. The mean systolic blood pressure (SBP) of the respondents was 127.64 mmHg, (range 80–190), while the mean diastolic blood pressure (DBP) was 80.19 mmHg (range 48–164). Most (78%) of them were currently taking medication for HTN. Some (34.4%) reported a family history of HTN; 5.50% mentioned being diagnosed with other chronic health conditions, including diabetes mellitus, hemiparesis, and thyroid issues [Table 2].

Table 3 shows the level of prevention-based color-coded stratification of the respondents. More than one-fifth (57) respondents were free of any evidence of HTN; 99 (39%) were at risk of developing HTN; 36(14%) diagnosed HTN cases were without any apparent complications, while 53(21%) had some complications. Eleven (4%) respondents needed rehabilitation.

DISCUSSION

Uncontrolled BP is one of the main risk factors for cardiovascular disease (CVD) which are responsible for one-third of total deaths in India. The prevalence of HTN in adult men and women have been reported to be 30–35% globally.^[11] In India also, it was 29–33%, that is, at least one in three adults has HTN.^[12,13] In our study also, the point prevalence of HTN was 39% in women. Thus, our findings are in tandem with the scenario elsewhere in India. Almost one-third of them were recently diagnosed (<1 year). This indicated a consistent incidence of HTN in the community. One-fifth of them were chronic cases (>10 years since diagnosis).

Color coding is a systematic process of displaying information using different colors to assist in classification and identification. The Color coding system is used in many diagnostics and therapeutic modalities. Risk profiling through a color-coded client segmentation-based public health approach is useful in educating the community to deal with the problem of HTN and averting deaths due to acute hypertensive disorders.^[5-10]

In low-income settings, the use of color coding in health systems has enhanced the quality of healthcare services by field workers, to classify ailments based on colors, diagnose the disease, start the appropriate treatment, and ensure better compliance. This endeavor has managed to improve existing poor health indicators. It also minimizes human errors in diagnosing and therapeutic modalities.

In our study, a level of prevention approach was applied simultaneously along with the color-coded stratification of the respondents. This involved the application of an individualized patient care approach by providing them with different colored cards on which HTN-related advice was written as per the level of prevention needed.

For example, green colored cards were provided to nonhypertensive participants whose SBP/DBP were normal. In this study, more than one-fifth (22%) of the respondents were eligible for being slotted in the health promotion segment; yellow colored cards were given to non-hypertensive participants with BP at borderline (SBP = 121139 mmHg and/or DBP = 8189 mmHg). Such respondents (39 %) were at risk, that is, to be put under specific protection (with a positive family history and obesity, etc.). Newly diagnosed patients were 14%; blue colored cards were given to these previously non-hypertensive participants with 1^st time BP readings of SBP >140 mmHg/or DBP >90 mmHg. They advocated early diagnosis/treatment. One-fourth of the respondents with complications had HTN-related cardiological interventions such as stents. Disability limitation was applicable in 21% of the cases; orange cards were provided to such known hypertensive patients. Red cards were given to the survivors of HTN-related complications, who needed rehabilitation (4 %).

CONCLUSION

The present study successfully used the color coding-based client segmentation comprehensive care program for HTN control in a community setting of UHTC of a private medical college.

This involved the application of an individualized patient care approach by providing them with different colored cards on which HTN-related advice is written as per the level of prevention needed. Overall, 39% of the respondents had HTN. About two-fifths of respondents were at risk of developing HTN. This method has the potential to enhance the individualized management of HTN.