Comprehensive Sex/Gender stratified analysis of Blood Pressure and Hypertension in India

Comprehensive Sex/Gender stratified analysis of Blood Pressure and Hypertension in India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comprehensive Sex/Gender stratified analysis of Blood Pressure and Hypertension in India Preben Bentdal, Anagha Joshi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9081940/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Hypertension is a major contributor to cardiovascular diseases, the leading cause of mortality in India. The sex/gender (SG) differences in the prevalence, progression, and treatment of hypertension exist, however there is no SG specific threshold for clinical hypertension detection. Understanding physio- logical and socio-economic correlates stratified by SG can inform the development of targeted, SG-specific prevention and treatment policies for hypertension. Methods: This study utilized data from two successive rounds of the Demo- graphic and Health Survey conducted in India (NFHS-4 and NFHS-5). The surveys incorporated demographic and health metrics, including systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements. Data from 1.8 million individuals (2019–2021) from NFHS-5 and 0.8 million individuals (2016–2017) from NFHS-4 were analyzed. Results: Our analysis revealed SG disparities in diverse aspects related to blood pressure in India. Men had overall higher levels of SBP and DBP compared to women. Age influenced SBP differently across SGs, with women experiencing a steeper rise starting in their mid-twenties, and no further SBP increase was observed post-menopause. In contrast, body mass index and waist circumference had a similar impact on BP across both SGs. Education demonstrated a marked SG-specific effect, with women possessing higher education levels being nearly twice as likely to maintain normal SBP compared to their uneducated coun- terparts. Furthermore, the risk of non-communicable diseases emerged at lower 1blood pressure thresholds in women than in men. Lastly, an SG-stratified treat- ment cascade analysis highlighted that women, although more likely to be aware of their hypertension, were less adherent to treatment compared to men. Female awareness and adherence saturated at the lower blood pressure threshold. Conclusion: First and foremost, evidence needs to be gathered for SG-specific hypertension threshold. Strong negative association between education and hypertension in women, might suggest preventative strategies should priori- tize education for women as a highly effective intervention. Additionally, while awareness initiatives should focus more on men, adherence support must be pri- oritized for women to enhance treatment outcomes. These findings underscore need for further studies for developing SG-specific guidelines in the prevention and management of hypertension. Hypertension Sex and gender Socio-economic factors Healthcare policies Non-communicable diseases Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigures.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 13 Mar, 2026 Editor assigned by journal 13 Mar, 2026 Submission checks completed at journal 13 Mar, 2026 First submitted to journal 10 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9081940","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621954543,"identity":"b3f06e1a-5e64-4ace-a864-b740a9c9a1dd","order_by":0,"name":"Preben Bentdal","email":"","orcid":"","institution":"University of Bergen","correspondingAuthor":false,"prefix":"","firstName":"Preben","middleName":"","lastName":"Bentdal","suffix":""},{"id":621954549,"identity":"5ad0f1e8-a669-4f35-ab0b-78f61414cfa2","order_by":1,"name":"Anagha Joshi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3PMQuCQBTA8RcHThe3PsmtL/BAkKKir2IEtZgEQVNEIDhFs9+jL6AITlarUFtjixBEU3RBg5M6Bt0f3nDwfjwOQKX6wTQ5TI4A4BDmgHYlEV/CPiQK6hB9UyCMA1QTOnvX23wFTIhDFA/8jgstLywnl8TqBQkwPXDteObjAoyk/BJltmVyDRhlnD5ktEGHSskwmz5M/pLklFLcrUMoc8xr04c2hQ7FjZpkyZo7tPTAoWh7xIWGk6q/TPd3/ugbQqRm/lyuXYHjsJTINATAwrNqX8byGksqlUr1z70BvDFBqnqU9ywAAAAASUVORK5CYII=","orcid":"","institution":"University of Bergen","correspondingAuthor":true,"prefix":"","firstName":"Anagha","middleName":"","lastName":"Joshi","suffix":""}],"badges":[],"createdAt":"2026-03-10 09:25:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9081940/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9081940/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106960709,"identity":"97239529-04fb-4804-b2f5-2d4d7f6c4bdf","added_by":"auto","created_at":"2026-04-15 09:22:46","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1717231,"visible":true,"origin":"","legend":"","description":"","filename":"IndiaBloodPressureBentdal2026.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9081940/v1_covered_1d263da0-0afb-4ea5-a467-09d343494bba.pdf"},{"id":106920443,"identity":"3b4ea432-3b94-4ae6-b9d0-e0ac78b92d0e","added_by":"auto","created_at":"2026-04-14 19:36:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2770052,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9081940/v1/ccb99322954ec44f2d59bb7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comprehensive Sex/Gender stratified analysis of Blood Pressure and Hypertension in India","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Sex and gender, Socio-economic factors, Healthcare policies, Non-communicable diseases","lastPublishedDoi":"10.21203/rs.3.rs-9081940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9081940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Hypertension is a major contributor to cardiovascular diseases,\u003c/p\u003e\n\u003cp\u003ethe leading cause of mortality in India. The sex/gender (SG) differences in the\u003c/p\u003e\n\u003cp\u003eprevalence, progression, and treatment of hypertension exist, however there is no\u003c/p\u003e\n\u003cp\u003eSG specific threshold for clinical hypertension detection. Understanding physio-\u003c/p\u003e\n\u003cp\u003elogical and socio-economic correlates stratified by SG can inform the development\u003c/p\u003e\n\u003cp\u003eof targeted, SG-specific prevention and treatment policies for hypertension.\u003c/p\u003e\n\u003cp\u003eMethods: This study utilized data from two successive rounds of the Demo-\u003c/p\u003e\n\u003cp\u003egraphic and Health Survey conducted in India (NFHS-4 and NFHS-5). The\u003c/p\u003e\n\u003cp\u003esurveys incorporated demographic and health metrics, including systolic blood\u003c/p\u003e\n\u003cp\u003epressure (SBP) and diastolic blood pressure (DBP) measurements. Data from\u003c/p\u003e\n\u003cp\u003e1.8 million individuals (2019–2021) from NFHS-5 and 0.8 million individuals\u003c/p\u003e\n\u003cp\u003e(2016–2017) from NFHS-4 were analyzed.\u003c/p\u003e\n\u003cp\u003eResults: Our analysis revealed SG disparities in diverse aspects related to blood\u003c/p\u003e\n\u003cp\u003epressure in India. Men had overall higher levels of SBP and DBP compared to\u003c/p\u003e\n\u003cp\u003ewomen. Age influenced SBP differently across SGs, with women experiencing\u003c/p\u003e\n\u003cp\u003ea steeper rise starting in their mid-twenties, and no further SBP increase was\u003c/p\u003e\n\u003cp\u003eobserved post-menopause. In contrast, body mass index and waist circumference\u003c/p\u003e\n\u003cp\u003ehad a similar impact on BP across both SGs. Education demonstrated a marked\u003c/p\u003e\n\u003cp\u003eSG-specific effect, with women possessing higher education levels being nearly\u003c/p\u003e\n\u003cp\u003etwice as likely to maintain normal SBP compared to their uneducated coun-\u003c/p\u003e\n\u003cp\u003eterparts. Furthermore, the risk of non-communicable diseases emerged at lower\u003c/p\u003e\n\u003cp\u003e1blood pressure thresholds in women than in men. Lastly, an SG-stratified treat-\u003c/p\u003e\n\u003cp\u003ement cascade analysis highlighted that women, although more likely to be aware\u003c/p\u003e\n\u003cp\u003eof their hypertension, were less adherent to treatment compared to men. Female\u003c/p\u003e\n\u003cp\u003eawareness and adherence saturated at the lower blood pressure threshold.\u003c/p\u003e\n\u003cp\u003eConclusion: First and foremost, evidence needs to be gathered for SG-specific\u003c/p\u003e\n\u003cp\u003ehypertension threshold. Strong negative association between education and\u003c/p\u003e\n\u003cp\u003ehypertension in women, might suggest preventative strategies should priori-\u003c/p\u003e\n\u003cp\u003etize education for women as a highly effective intervention. Additionally, while\u003c/p\u003e\n\u003cp\u003eawareness initiatives should focus more on men, adherence support must be pri-\u003c/p\u003e\n\u003cp\u003eoritized for women to enhance treatment outcomes. These findings underscore\u003c/p\u003e\n\u003cp\u003eneed for further studies for developing SG-specific guidelines in the prevention\u003c/p\u003e\n\u003cp\u003eand management of hypertension.\u003c/p\u003e","manuscriptTitle":"Comprehensive Sex/Gender stratified analysis of Blood Pressure and Hypertension in India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 19:36:09","doi":"10.21203/rs.3.rs-9081940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"335584272233140983326505554714842665020","date":"2026-04-15T02:01:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T11:51:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-13T16:29:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T04:14:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T04:14:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-03-10T09:08:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6580913-b61d-4e87-a3b7-01b6f866ea9a","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T19:36:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 19:36:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9081940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9081940","identity":"rs-9081940","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}