Blood pressure control assessed by clinic and home blood pressure measurements among hypertensive patients in India: results from the GRAND study

Abstract Hypertension is a prevalent non-communicable disease and a significant cardiovascular risk factor in India, affecting 25% of adults. Among those treated, only 52.5% achieved controlled clinic blood pressure (CBP). We investigated blood pressure (BP) control in India using CBP and home BP (HBP). This multicenter, cross-sectional study across 18 centers in 12 states within 7 regions enrolled hypertensive participants aged 20–70 years receiving antihypertensive medications for ≥3 months who regularly visited their clinic. A background survey and four CBP readings were collected at baseline (“Clinic Visit 1”) and Clinic Visit 2. Participants underwent HBP monitoring for seven days. Based on average CBP across the two clinic visits and average HBP, participants were classified as having well-controlled hypertension (CBP < 140/90 mmHg and HBP < 135/85 mmHg), white-coat uncontrolled hypertension (WUCH; CBP ≥ 140/90 mmHg and HBP < 135/85 mmHg), masked uncontrolled hypertension (MUCH; CBP < 140/90 mmHg and HBP ≥ 135/85 mmHg), or sustained uncontrolled hypertension (SUCH; CBP ≥ 140/90 mmHg and HBP ≥ 135/85 mmHg). Among 1920 participants, 1578 with appropriate CBP and HBP readings were analyzed. Of these, 55.9% had well-controlled hypertension, 5.1% had WUCH, 21.8% had MUCH, and 17.2% had SUCH. The proportion classified as controlled was 77.7% using clinic BP alone versus 55.9% using both clinic and home BP, a difference of 21.8 percentage points. These findings highlight the importance of incorporating HBP alongside CBP for comprehensive assessment of BP control and identification of BP control phenotypes. Clinical trial registration: Registered at Clinical Trials Registry-India (CTRI) under CTRI/2023/02/049486 on 06 February 2023.