Despite improved medical management, cardiovascular disease (CVD) remains the leading cause of mortality for both men and women in the United States¹ and worldwide², with other vascular-related diseases such as stroke, diabetes, and chronic kidney disease ranking in the top 10¹. Hypertension (HTN), an elevation in blood pressure (BP) meeting a cut-point, is a major modifiable risk factor for these conditions³,⁴.

MATERIALS AND METHODS

This cross-sectional, hospital-based study was conducted at the tertiary care hospital Gonda, Uttar Pradesh over one year (September 2024 – August 2025)¹,². All adult outpatients aged ≥18 years were eligible, excluding pregnant women, critically ill patients, and those unable to provide informed consent³. BP measurements followed standard protocol using validated automated sphygmomanometers⁴,⁵. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg or current antihypertensive medication⁵. Awareness, treatment, and control were defined according to standard definitions⁶,⁷. Complications including hypertensive heart disease, stroke/TIA, CKD, and retinopathy were assessed⁸,⁹. Statistical analysis was performed using SPSS v25; logistic regression identified predictors with p<0.05 considered significant⁹,¹⁰.

Study Population:

All adult outpatients aged ≥18 years who visited the OPD during the study period were considered. Exclusion criteria included pregnant women, critically ill patients requiring emergency care, and those unable to provide informed consent.

Sample Size and Sampling:

A total of 44,367 consecutive consenting adults were screened. Consecutive sampling ensured that all eligible patients visiting the OPD were included, minimizing selection bias.

Blood Pressure Measurement Protocol:

- BP was measured using a validated automated sphygmomanometer.

- Patients rested seated for 5 minutes prior to measurement.

- Two readings were taken at 1–2 minute intervals; the average of the two readings was recorded.

- Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg, or current use of antihypertensive medication.

Definitions:

- Awareness: self-report of prior diagnosis by a health professional.

- Treatment: current use of antihypertensive medication.

- Control: treated patients with BP <140/90 mmHg.

- Complications: included hypertensive heart disease, stroke/TIA, chronic kidney disease, hypertensive retinopathy, and peripheral artery disease.

Data Collection and Ethical Considerations:

- Demographics: age, sex, residence, BMI, comorbidities, smoking, alcohol.

- Informed consent obtained; study approved by Institutional Ethics Committee.

Statistical Analysis:

- Data analyzed using SPSS v25. Continuous variables as mean ± SD; categorical as n (%).

- Prevalence, awareness, treatment, control, and complications calculated with 95% CI.

- Logistic regression to identify predictors. p<0.05 significant.

RESULTS

Demographics and Baseline Characteristics:

Total participants: 44,367; mean age 46.8 ± 12.3 years. Males: 54.8%, Females: 45.2%. Mean BMI: 25.1 ± 3.8 kg/m². Diabetes mellitus: 12%, Smoking/tobacco use: 20.5%.

Prevalence of Hypertension:

Overall prevalence: 28.5% (12,646 patients; 95% CI: 27.9–29.1). Newly diagnosed cases: 47.7% of hypertensives. Prevalence increased with age, highest in ≥60 years.

Awareness, Treatment, and Control:

Awareness: 52.3% of hypertensive patients; Treatment: 45.7%; Control: 19.8%.

Complications of Hypertension:

Hypertensive heart disease: 8.9%; Stroke/TIA: 5.1%; Chronic kidney disease: 4.3%; Retinopathy: 3.2%; Peripheral artery disease: 1.0%; At least one complication: 22.5%.

Predictors of Hypertension:

Age: aOR 1.48 per 10-year increase (95% CI 1.39–1.57); BMI ≥25 kg/m²: aOR 1.67 (95% CI 1.53–1.81); Diabetes: aOR 1.42 (95% CI 1.31–1.55).

Tables and Charts

Table 1. Baseline Characteristics of Participants (n=44,367)

Table 2. Hypertension Prevalence, Awareness, Treatment, and Control

Table 3. Hypertension-Related Complications among Hypertensive Patients (n=12,646)

DISCUSSION

The prevalence aligns with NFHS-5 and ICMR-INDIAB¹,². Awareness and control remain suboptimal³,⁴. Approximately 22.5% had target organ damage⁵–⁷. Persistent high BP causes vascular remodeling, endothelial dysfunction, and organ injury⁸. Early detection, lifestyle modification, and adherence to therapy are essential⁹,¹⁰.

Principal Findings:

High prevalence (28.5%) of hypertension among outpatients; nearly half unaware, only one-fifth controlled. Significant gaps in early detection and management.

Comparison with Literature:

Consistent with NFHS-5 and ICMR-INDIAB surveys; awareness and control remain suboptimal in India.

Complications:

22.5% had target organ damage; hypertensive heart disease most common, followed by stroke, CKD, and retinopathy. Chronic uncontrolled hypertension leads to vascular remodeling, endothelial dysfunction, and organ damage.

Strengths:

Large sample size, standardized BP measurement, consecutive patient inclusion.

Limitations:

Single-center study, cross-sectional design, incomplete investigations for some complications.

Implications for Practice:

Routine OPD screening, lifestyle modification counseling, adherence support, and referral to specialists recommended.

CONCLUSION

High burden of hypertension, low awareness and control, and frequent complications. Systematic screening and early intervention are key.

REFERENCES

1. Whelton PK, Carey RM, Aronow WS, et al. Hypertension. 2018;71(6):e13–e115.
2. Forouzanfar MH, et al. Lancet. 2017;389:37–55.
3. Anchala R, Kannuri NK, Pant H, et al. J Hypertens. 2014;32:1170–1177.
4. Varghese JS, et al. JAMA Netw Open. 2023;6:eXXXXX.
5. Gupta R, Xavier D. Indian Heart J. 2018;70:565–572.
6. Messerli FH, Williams B, Ritz E. Lancet. 2007;370:591–603.
7. Chobanian AV, et al. JAMA. 2003;289:2560–2572.
8. Forouzanfar MH, et al. Lancet. 2017;389:37–55.
9. Global brief on hypertension. Geneva: WHO; 2013.
10. Kaur P, et al. J Hum Hypertens. 2025;XX:XX–XX.