Evidence map›Paper›PMID 30442122›Full record

Trial reportBMC public health2018

Cardiovascular disease risk and comparison of different strategies for blood pressure management in rural India.

Devarsetty Praveen, David Peiris, Stephen MacMahon, Kishor Mogulluru, Arvind Raghu, Anthony Rodgers, Shailaja Chilappagari, Dorairaj Prabhakaran, Gari D Clifford, Pallab K Maulik and 5 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC public health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Devarsetty PraveenThe George Institute for Global Health, Hyderabad, India. dpraveen@georgeinstitute.org.in.ORCID http://orcid.org/0000-0002-0973-943X
David PeirisThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Stephen MacMahonThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Kishor MogulluruThe George Institute for Global Health, Hyderabad, India.
Arvind RaghuInstitute of Biomedical Engineering, University of Oxford, Oxford, UK.
Anthony RodgersThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Shailaja ChilappagariThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Dorairaj PrabhakaranCentre for Chronic Disease Control, New Delhi, India.
Gari D CliffordDepartment of Biomedical Informatics, Emory University, Atlanta, GA, USA.
Pallab K MaulikThe George Institute for Global Health, Delhi, India.
Emily AtkinsThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Rohina JoshiThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Stephane HeritierMonash University, Melbourne, Australia.
Stephen JanThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.
Anushka PatelThe George Institute for Global Health, The University of New South Wales, Sydney, Australia.

Funding

National Health and Medical Research Council ID1040147Wellcome Trust
6 · The paper itself

Abstract

backgroundNon-optimal blood pressure (BP) levels are a major cause of disease burden globally. We describe current BP and treatment patterns in rural India and compare different approaches to BP lowering in this setting.

methodsAll individuals aged ≥40 years from 54 villages in a South Indian district were invited and 62,194 individuals (84%) participated in a cross-sectional study. Individual 10-year absolute cardiovascular disease (CVD) risk was estimated using WHO/ISH charts. Using known effects of treatment, proportions of events that would be averted under different paradigms of BP lowering therapy were estimated.

resultsAfter imputation of pre-treatment BP levels for participants on existing treatment, 76·9% (95% confidence interval, 75.7-78.0%), 5·3% (4.9-5.6%), and 17·8% (16.9-18.8%) of individuals had a 10-year CVD risk defined as low (< 20%), intermediate (20-29%), and high (≥30%, established CVD, or BP > 160/100 mmHg), respectively. Compared to the 19.6% (18.4-20.9%) of adults treated with current practice, a slightly higher or similar proportion would be treated using an intermediate (23·2% (22.0-24.3%)) or high (17·9% (16.9-18.8%) risk threshold for instituting BP lowering therapy and this would avert 87·2% (85.8-88.5%) and 62·7% (60.7-64.6%) more CVD events over ten years, respectively. These strategies were highly cost-effective relative to the current practice.

conclusionIn a rural Indian community, a substantial proportion of the population has elevated CVD risk. The more efficient and cost-effective clinical approach to BP lowering is to base treatment decisions on an estimate of an individual's short-term absolute CVD risk rather than with BP based strategy. CLINICAL

trial registrationClinical Trials Registry of India CTRI/2013/06/003753 , 14 June 2013.

Indexed as

Rural PopulationAdultAgedCardiovascular DiseasesCross-Sectional StudiesFemaleHumansHypertensionIndiaMaleMiddle AgedRiskAbsolute riskBlood pressureCardiovascular diseaseIndiaTreatment

Identifiers

PMID30442122
PMCPMC6238360

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.