Hypertension burden in Northwest India: a systematic review of prevalence, risk factors and care cascade in Punjab and Haryana (2021-2026)

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.