Hypertension and associated health behaviours among hypertensive adults in selected urban and rural communities of Nellore district, Andhra Pradesh, India: a cross-sectional study

Hypertension is a major contributor to cardiovascular mortality and morbidity in India, but national estimates mask state- and district-level variation. We assessed the prevalence, awareness, treatment, and control of hypertension, and associated health behaviours, among adults in Nellore district, Andhra Pradesh. We conducted a cross-sectional, door-to-door survey of 750 adults aged 18 years and above, selected through multi-stage cluster random sampling from one urban ward and three rural panchayats in Nellore district. Data were collected using a structured questionnaire together with standardized blood pressure and waist circumference measurements. Health behaviours [hypertension treatment, regular follow-up, attempted diet control, attempted physical activity] were self-reported. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication. Weighted prevalence estimates with 95% confidence intervals (CI) were computed, and generalised estimation equations specified with binominal distribution and logic link were used to estimate adjusted odds ratios (AOR) for factors associated with hypertension, awareness, control, and health behaviours. Hypertension was present in 39.7% of participants (309/750; 95% CI 33.1–46.8). Among hypertensive individuals ( n = 309), 64.0% were aware of their status, and among those aware ( n = 200), 85.9% were on treatment, and 44.4% had their blood pressure controlled. Among hypertensive-aware individuals, regular monthly follow-up was reported by 70.6%, attempted diet control by 48.3%, and attempted physical activity by only 17.2%. Female sex (AOR 1.93, 95% CI 1.13–3.30), older age (AOR 8.56, 95% CI 4.61–15.92 for ≥ 61 years), and diabetes (AOR 1.89, 95% CI 1.21–2.94) were associated with higher odds of hypertension, while female sex was associated with lower odds of control (AOR 0.37, 95% CI 0.15–0.93). Self-reported diabetes was associated with awareness of hypertension status (AOR 3.56, 95% CI 1.80–7.00). Four in ten adults surveyed were hypertensive, and two out of three hypertensive individuals were aware of their status. While treatment status among those aware is high, less than half had blood pressure under control. Health behaviours like attempting dietary control and regular physical activity are low.