Hypertension burden in Northwest India: a systematic review of prevalence, risk factors and care cascade in Punjab and Haryana (2021-2026)
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20262752Keywords:
Hypertension, Prevalence, Risk factors, Punjab, Haryana, Blood pressureAbstract
Hypertension is the leading modifiable risk factor for cardiovascular disease, stroke, and premature mortality globally. Punjab and Haryana, two high-income agricultural states of northwestern India, have consistently reported hypertension prevalence rates substantially exceeding the national average, driven by distinctive socio-cultural, dietary, and occupational risk profiles. A systematic review was conducted using PubMed/Medline, Google Scholar, and Web of Science for peer-reviewed studies published from January 2021 to May 2026 reporting hypertension prevalence and/or risk factors among adults (age ≥18 years) in Punjab or Haryana. PRISMA guidelines were followed. Of 400 records identified, 46 studies were included after rigorous screening. In Punjab, hypertension prevalence ranged from 24.3% to 40.1% in state-wide surveys, and reached 62% in Ludhiana. In Haryana, prevalence ranged from 17.26% to 59% across community and facility-based studies. A prospective cohort study documented a significant rise from 34.4% to 40.4% over eight years in rural Haryana. Hypertension awareness was 48.3%, treatment 30.9%, and control 18.3% in Punjab; in Haryana, awareness was 33.4%, treatment 26.3%, and control was only 12%. Major risk factors included increasing age, male sex, obesity, high dietary salt intake, physical inactivity, tobacco and alcohol use, diabetes mellitus, dyslipidaemia, and psychological stress. A novel finding was global DNA hypomethylation as an epigenetic correlate of hypertension in rural Punjab. The hypertension burden in Punjab and Haryana continues to rise with suboptimal awareness, treatment, and control (ATC) rates. Expansion of the India Hypertension Control Initiative, targeted dietary and occupational health programmes, and district-representative longitudinal studies are urgently required.
References
Jose AP, Prabhakaran D. World hypertension day: contemporary issues faced in India. Indian J Med Res. 2019;149(5):567-70.
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37.
World Health Organization. Global report on hypertension: the race against a silent killer. Geneva: WHO. 2023. Available at: https://www.who.int/publications/i/item/9789240081062. Accessed on 3 June 2026.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS. 2022.
NCD Risk Factor Collaboration (NCD-RiSC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37-55.
Ministry of Health and Family Welfare. Operational guidelines for the India Hypertension Control Initiative (IHCI). New Delhi: Government of India. 2020.
Gupta R, Gaur K, Ram CVS. Emerging trends in hypertension epidemiology in India. J Hum Hypertens. 2019;33(8):575-87.
Thakur JS, Nangia R. Prevalence, awareness, treatment, and control of hypertension and diabetes: results from two state-wide STEPS surveys in Punjab and Haryana, India. Front Public Health. 2022;10:768471.
Longkumer I, Yadav S, Rajkumari S, Saraswathy KN. Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India. Sci Rep. 2023;13(1):9910.
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49.
Sekhon CK, Kaur R, Airi M. Incidence of hypertension and its risk factors: a systematic review. Int J Community Med Public Health. 2024;11(3):1282.
Jaacks LM, Awasthi A, Bhupathiraju S, Bhawna, Cunningham SA, Narayan KMV, et al. A community-based noncommunicable disease prevention intervention in Punjab, India: baseline characteristics of 11,322 adults. Indian J Community Med. 2022;47(1):23-9.
Mitra C, Lal M, Mitra A, Kaur A, Gupta R. A study to determine the role of modifiable and non-modifiable risk factors for hypertension among rural population of district Amritsar. Natl J Physiol Pharm Pharmacol. 2021;11(11):1257.
Singh J, Iqbal SA, Mohammed TI, Kumari R, Singh S, Kaur H, et al. Prevalence and associated risk factors of hypertension in rural and urban areas of Punjab: a cross-sectional study. J Fam Med Prim Care. 2025;14(2):757-61.
Kaushik A, Bhattacharjee D, Chaudhary V, Singh B, Kaur R, Sekhon CK, et al. Hypertension and global DNA methylation: a population-based study in rural Punjab, India. Sci Rep. 2024;14(1):25826.
Yadav K, Gupta P, Agarwal N, Bansal N, Bali S, Gupta R, et al. Attributes of hypertension among industrial workers in Northern India: an alarming signal. J Fam Med Prim Care. 2024;13(1):330-5.
Vashist S, Gupta N, Singh G, Singla N, Sharma K. An epidemiological study of prevalence and predictors of hypertension among adults aged 30-70 years in rural Gurugram, Haryana. Indian J Community Health. 2026;38(2):358-65.
Narang S, Singh M, Yadav J, Dixit S, Singh N. Prevalence of hypertension amongst employee's state insurance beneficiaries of four districts in Haryana. Int J Community Med Public Health. 2020;7(2):604-8.
Silan VK, Verma RK, Pal R. An unattended silent killer: a facility-based cross-sectional study on undiagnosed hypertension from Haryana, India. Asian J Med Sci. 2022;13(9):136-41.
Shergill GS, Singh M, Bhatt G, Gill Z. Prevalence of depression and anxiety in patients with hypertension at a secondary level government health-care facility in northern India. Int J Recent Sci Res. 2022;13(5):1311-6.
Sindwani P, Sharma S, Ahmad A, Kumar A, Dalal S, Jain P. The burden of hypertension and prehypertension in a community health centre of Haryana. Cureus. 2023;15(1):e33569.
Kaur P, Pattabi K, Gunasekaran A, Kiran T, Prabhakaran D, Huffman MD, et al. Population-based surveillance for hypertension awareness, treatment, and control in nine districts: India Hypertension Control Initiative, 2018-19. J Hum Hypertens. 2025;39:376-86.
Kaur P, Sakthivel M, Venkatasamy V, Subramani SK, Sivasubramanian M, Ramakrishnan N, et al. India Hypertension Control Initiative: blood pressure control using drug and dose-specific standard treatment protocol at scale in Punjab and Maharashtra, India, 2022. Glob Heart. 2024;19(1):30.
Chavan TA, Kaviprawin M, Sakthivel M, Ramakrishnan N, Kaur P, Prabhakaran D, et al. India Hypertension Control Initiative: decentralisation of hypertension care to health and wellness centres in Punjab and Maharashtra, India, 2018-2022. BMC Health Serv Res. 2024;24:855.
Pedgaonkar SP, Kumar K. Clustering of hypertension and diabetes within households across districts of India: a cross-sectional analysis using a nationally representative household survey. PLOS Glob Public Health. 2025;5(6):e0004648.
Gupta S, Kumar R, Kalaivani M, Nongkynrih B, Kant S, Gupta SK. Prevalence, awareness, treatment, and control of diabetes and hypertension among elderly persons in a rural area of Ballabgarh, Haryana. J Fam Med Prim Care. 2020;9(2):1-13.
Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S. Alarmingly high prevalence of hypertension and pre-hypertension in North India: results from a large cross-sectional STEPS survey. PLoS One. 2017;12(12):e0188619.
Mitra C, Lal M, Singh T, Deepti SS. Prevalence and role of risk factors for hypertension in 18-69 years of age in rural and urban areas of district Amritsar, Punjab, India. Int J Community Med Public Health. 2017;4(2):460-4.
Mohammad R, Bansod DW. Hypertension in India: a gender-based study of prevalence and associated risk factors. BMC Public Health. 2024;24:2681.
Thakur JS, Jeet G, Pal A, Singh S, Singh A, Deepti SS, et al. Profile of risk factors for non-communicable diseases in Punjab, Northern India: results of a state-wide STEPS survey. PLoS One. 2016;11(7):e0157705.
Thakur JS, Jeet G, Nangia R, Singh D, Grover S, Lyngdoh T, et al. Non-communicable diseases risk factors and their determinants: a cross-sectional state-wide STEPS survey, Haryana, North India. PLoS One. 2019;14(11):e0208872.
Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Subramanian SV. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: a nationwide cohort study. PLoS Med. 2022;19(1):e1003855.
Koya SF, Pilakkadavath Z, Chandran P, Shaffi M, Fahal AH, Wilson F, et al. Hypertension control rate in India: systematic review and meta-analysis of population-level non-interventional studies, 2001-2022. Lancet Reg Health Southeast Asia. 2023;9:100142.
Downloads
Published
How to Cite
Issue
Section
