Additive association of knowledge and awareness on control of hypertension: a cross sectional survey in rural India.

Abstract

D r Ragavan and colleagues report on the association between both awareness of hypertension and knowledge about the causes and consequences of hypertension on the treatment and control of high blood pressure (BP) [1]. This report is based on 3455 hypertensive adults detected in a large cross-sectional survey of 11 657 residents of three socioeconomically diverse rural regions in India. The authors point out that awareness and knowledge of hypertension have previously been shown to be associated with better treatment and control of high BP, but not whether the effects are independent and additive, particularly in a relatively low-income setting, such as rural India. The survey, carried out between January 2014 and December 2015, appears to have been carefully designed and carried out by well trained investigators in randomly selected areas and on population-based samples. BPs were measured in a remarkably rigorous way, involving between three to five recordings after sitting for 15min and using the mean of the last two readings in analyses. Whether three, four or five readings were taken depend on whether two consecutive readings differed by less than 10/6 mmHg. Few surveys go to such elaborate lengths to try to deal with varying degrees of white-coat or acclimatization phenomena! Meanwhile, the use of the last two of three readings is to be generally recommended having been established using the vast May Measurement Month database [2]. The study exposures – knowledge and awareness were measured via a 10-item questionnaire and a yes/no response to whether a previous diagnosis had been made, respectively. Study outcomes – treatment for hypertension and controlled BP – were based on self-reported use of medication