Prevalence of Hypertension among Indian Adults Based on Global Standards: Evidence from a nationally representative survey(NFHS-5)
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Introduction
Hypertension (HTN) is defined using varying systolic and diastolic thresholds across global guidelines and surveys. In India, the National Family Health Survey 5(NFHS 5) reports HTN among individuals >15 years, classifying it as mild, moderate, or severe, whereas international frameworks such as JNC 7, AHA, and ISH apply different cut offs for those >18 years. Such inconsistencies complicate clinical decision making, hinder policy formulation, and limit research comparability. This study aimed to assess the variability in HTN prevalence when applying different classification criteria and to underscore the need for a standardized framework.
Methods
We analyzed secondary data from NFHS 5, restricting the sample to men (18 to 54 years) and women (18 to 49 years). Analyses were performed using SPSS 29.0. Prevalence was reported with 95% confidence intervals (CI), and multivariate logistic regression estimated adjusted odds ratios (AORs). Pre hypertensives (JNC 7), elevated BP (AHA), and high normal BP (ISH) categories were excluded.
Results
NFHS 5 reported HTN prevalence of 21.3% in women (15 to 49 years) and 24% in men (15 to 54 years). Applying JNC/ISH cut offs to the same cohort yielded lower prevalence: 12.35% (95% CI: 12.27, 12.43) in women and 21.78% (95% CI: 21.49, 22.07) in men. By contrast, AHA criteria produced substantially higher estimates: 45.53% (95% CI: 45.41, 45.65) in women and 62.55% (95% CI: 62.22, 62.28) in men. Multivariate analysis showed significantly higher odds of HTN among individuals with BMI >25, lowest education, highest wealth quintile, alcohol use, smoking, and diabetes.
Conclusions
HTN prevalence varies markedly depending on the classification applied, revealing inconsistencies across NFHS, JNC 7, AHA, and ISH guidelines. This variability risks fragmented policy, inequitable treatment decisions, and reduced comparability of research. Establishing a uniform, globally accepted HTN classification framework is essential to strengthen surveillance, harmonize clinical practice, and accelerate progress toward reducing the global hypertension burden by 2030 (SDG).
