From the Guidelines
To diagnose hypertension in India, healthcare providers should follow a systematic approach that begins with proper blood pressure measurement, considering the presence of additional cardiovascular risk factors, as recommended by the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1. When diagnosing hypertension, it is essential to consider the high prevalence of additional cardiovascular risk factors, such as diabetes, lipid disorders, overweight-obesity, hyperuricemia, and metabolic syndrome, which are common in hypertensive patients in India.
- The diagnostic approach should include an evaluation of these additional risk factors, particularly in the presence of a family history of cardiovascular disease (CVD).
- Blood pressure should be measured at least twice during each of two or more office visits, using a calibrated sphygmomanometer after the patient has been seated quietly for 5 minutes with back supported and arm at heart level.
- Hypertension is diagnosed when the average of two or more properly measured readings on two or more occasions shows systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg.
- For more accurate diagnosis, ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) is recommended, with hypertension defined as 24-hour average BP ≥130/80 mmHg on ABPM or average BP ≥135/85 mmHg on HBPM, as suggested by the guidelines 1. After diagnosis, patients should undergo evaluation for target organ damage and cardiovascular risk factors through tests including complete blood count, fasting blood glucose, lipid profile, serum creatinine, electrolytes, urinalysis, and ECG, considering the patient's overall cardiovascular risk profile, as outlined in the guidelines 1.
- Additional tests like echocardiography may be needed based on clinical findings.
- Secondary causes of hypertension should be considered, especially in young patients, those with sudden onset of hypertension, or resistant hypertension.
- The Indian guidelines recommend considering ethnic factors and a lower threshold for intervention in South Asians due to their higher cardiovascular risk at lower blood pressure levels compared to Western populations, which is also supported by the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1.
From the Research
Diagnosing Hypertension in India
To diagnose hypertension in India, the following methods can be used:
- Office blood pressure measurement (OBPM)
- Home blood pressure monitoring (HBPM)
- Ambulatory blood pressure monitoring (ABPM)
Office Blood Pressure Measurement
Office blood pressure measurement is a common method used to diagnose hypertension. However, it has its limitations, as it can lead to misdiagnosis and mistreatment due to variations in blood pressure values in different settings 2.
Home Blood Pressure Monitoring
Home blood pressure monitoring is recognized as a valuable tool to diagnose and support hypertension treatment, including the prevention of cardiovascular diseases (CVD) and target organ damage 3. A study found that HBPM instructions to patients are either lacking or not well aligned with local hypertension guidelines, which may have led to low HBPM use among patients 3.
Ambulatory Blood Pressure Monitoring
Ambulatory blood pressure monitoring provides short-term comprehensive information on blood pressure, including daytime, nighttime, morning, and 24-h blood pressure 2. ABPM is recommended for the initial diagnosis of hypertension, assessment of blood pressure phenotypes and circadian patterns, and detection of nocturnal hypertension 2.
Comparison of Methods
A study compared the diagnosis of hypertension based on home blood pressure monitoring, ambulatory monitoring, and repeated clinic blood pressure measurements 4. The results showed that there was disagreement between the methods, with hypertension diagnosed in 70% of individuals using clinic blood pressure, 63% using ambulatory monitoring, and 56% using home blood pressure monitoring 4.
Recommendations
For diagnosing hypertension in India, it is recommended to use a combination of methods, including office blood pressure measurement, home blood pressure monitoring, and ambulatory blood pressure monitoring 5, 2. The choice of method depends on the individual's specific needs and circumstances. Clear and practical educational materials and sessions are needed to improve the understanding of home blood pressure monitoring amongst physicians 3.
Key Findings
- Home blood pressure monitoring is a valuable tool for diagnosing and supporting hypertension treatment 3
- Ambulatory blood pressure monitoring provides comprehensive information on blood pressure 2
- Office blood pressure measurement has limitations and can lead to misdiagnosis and mistreatment 2
- A combination of methods is recommended for diagnosing hypertension in India 5, 2