Evidence map›Paper›PMID 35644270›Full record

ArticleIndian heart journal

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions.

Thekkumkara Prabhakaran Sreelal, Jissa Vinoda Thulaseedharan, Sanjeev Nair, Rekha Melathuparambil Ravindran, Krishnapillai Vijayakumar, Ravi Prasad Varma

Open access · goldAbstract read
In one paragraph

Article in Indian heart journal. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.8field-weighted citation impact, top 27% of its field
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

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Efficacy of nitroglycerinWorld journal of cardiology · 2026
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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

6 authors at 5 institutions in 1 country.

Thekkumkara Prabhakaran SreelalDM Wayanad Institute of Medical Sciences (WIMS) Medical College, Wayanad, Kerala, 673577, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India.
Jissa Vinoda ThulaseedharanAchutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
Sanjeev NairDepartment of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, 680596, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India.
Rekha Melathuparambil RavindranState Health Systems Resource Centre - Kerala, Thiruvananthapuram, Kerala, 695014, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India.
Krishnapillai VijayakumarHealth Action by People, Thiruvananthapuram, Kerala, 695011, India.
Ravi Prasad VarmaAchutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India. Electronic address: dr.rpvarma@gmail.com.
Sree Chitra Thirunal Institute for Medical Sciences and Technology · INGovernment Medical College · INHealth Action by People · INKerala Institute of Medical Sciences · INNational Health Systems Resource Centre · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India.

methodsThis cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression.

resultsTotally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50-2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy.

conclusionsIn this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.

Indexed as

Diabetes MellitusHypertensionAntihypertensive AgentsCross-Sectional StudiesHumansIndiaPrescriptionsSecondary Health CareAntihypertensive AgentsDrug therapyHealth care systemsHypertensionPrescriptions

Identifiers

PMID35644270
PMCPMC9453055
OpenAlexW4281739469

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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 Socratic graph.