Worldwide, around 1.28 million adults with age group of 30– 79 years have hypertension, majority of them residing in low and middle  and income countries (LMIC) [1]. Hypertension is considered as one of the significant public health concerns in India. As per the estimates of World Health Organization (WHO), the prevalence of hypertension in India is around 30%.[2] The overall prevalence of hypertension is reported as 25% in Maharashtra with 27% in urban areas and around 40% in rural areas [3]. One of the published research documents that hypertension was present in 30% of the urban and 20% of the rural population in India [4].

In context of India, nearly 62% of mortalities were due to non-infectious diseases, out of which, around 27% were contributed to cardiovascular health problems [5]. Ischemic heart disease and cerebrovascular accident (CVA) are the most pre-dominant form of cardiovascular diseases among Indians mainly due to variations in the epidemiological transition.[4,5] Atherosclerotic Cardiovascular Disease (ASCVD) refers to a set of conditions triggered by the increase of fats, cholesterol, and other substances like plaque inside the walls of arteries. As plaque collects, it narrows and stiffens the arteries, inhibiting normal, oxygen-rich blood flow to vital organs and tissues of the body [6, 7]. The ASCVD arises due to the combined effect of several risk factors. Therefore, it is a standard method to be utilized to estimate the risk of cardiovascular disease [6, 7].

The assessment of the individual’s risk for the development of ASCVD will enable the health care professionals to strengthen the preventive approaches including pharmacological as well as lifestyle changes.[6,7] One of the approved tools constructed to assist the clinicians in predicting the risk of cardiovascular events among hypertensive patients is the WHO/International Society of Hypertension (ISH) chart [8].  The WHO/ISH chart signifies ten year risk of a lethal or non-lethal major cardiovascular event (MACE), as per the age, gender, blood pressure, smoking habits, total blood cholesterol, status of type 2 diabetes mellitus [8].

The research, which is conducted across 21 regions worldwide, indicates that, WHO ISH chart will improve the accuracy, practicability as well as sustainability of efforts to decrease the magnitude of cardiovascular diseases at global level [8]. Additionally, the laboratory-based and non-laboratory-based WHO/ISH risk charts exhibit strong mutual concordance [7, 8]. Therefore, non-laboratory WHO/ISH chart can be appropriate for risk evaluation in the resource restricted areas [9]. The present study utilized non-laboratory based WHO/ISH chart to assess the prevalence of cardiovascular event risk among hypertensive patients in the age group of 40–70 years in a rural field practice area of an institute in Pune District of Maharashtra State.

A cross sectional study was carried out among hypertensive patients aged 40–70 years attending rural health center in field practice areas of an institute which is in rural region of Pune District of Maharashtra State of India. The existing study was approved by Institutional Ethics Committee of Brij Niramaya Memorial Hospital and Research Centre in Maharashtra, India (approval number: BMC/EC/617/2025). All 182 patients who were diagnosed with hypertension and attending health center during the period of 1st April 2025 to 31st December 2025 were included as study participants through Complete Enumeration Sampling (Census) Method.  Any hypertensive patients diagnosed with secondary hypertension and those who were not willing to participate in the study were excluded from the study.

In this study, operational definitions were formulated to ensure smooth collection of data. The participants were considered “alcoholic” if they consumed it more than one year on regularly or occasionally. The study participants were considered for “active work” if their work involved any kind of significant physical activity or movement. The data collection was accomplished through two methods namely self-administered questionnaire and face to face interviews using structured validated questionnaire. The questionnaire included sociodemographic attributes, personal habits, and details of pre-existing morbidities. The cardiovascular risk of the participants was evaluated using WHO/ISH chart.

The data were entered into Microsoft Office Excel Sheet and analyzed using Statistical Package for Social Services (SPSS) Version 31, IBM. Categorical variables were denoted as percentages and continuous variables as mean with standard deviation, if ordinarily distributed, and as median with interquartile range, if not ordinarily distributed. Multivariable logistic regression was utilized to assess the factors linked with cardiovascular event risk. P value <0.05 was considered as statistically significant.

The present study involved 182 participants. Table 1 indicates various sociodemographic attributes of participants and their relationship with CDER. Most of them belonged to age group of 51-60 years (44.50%), and around 56.04% of them were males [Table 1]. More than half of the participants (51.61%) belonged to the nuclear family, and most of them were having nonvegetarian diet [Table 1]. Around 34% and 33% of study participants were smokers and alcoholics respectively while nearly two thirds were involved in sedentary work (64.83%) [Table 1]. Table 1: Sociodemographic Features and Its Correlation with Cardiovascular Disease Event Risk (n=182) Parameter CVD P value <10%, n (%) >10%, n (%) Age 61–70 9 (4.94) 44 (24.17) <0.05* 51–60 38 (20.87) 43 (23.62) 40–50 37 (20.32) 11 (6.04) Gender Male 40 (21.97) 62 (34.06) 0.152 Female 42 (23.07) 38 (20.87) Diet Nonvegetarian 66 (36.26) 92 (50.54) <0.05* Vegetarian 16 (8.79) 8 (4.39) Smoking Yes 19 (31.25) 58 (47.97) <0.05* No 62 (52.03) 43 (68.75 Alcohol Yes 18 (9.89) 61 (33.51) <0.05* No 63 (34.61) 40 (21.97) Type 2 Diabetes Yes 33 (32.99) 64 (67.01) <0.05* No 50 (57.78) 35 (19.23) Work Pattern Sedentary work 55 (30.76) 63 (34.61) 0.324 Active work* 26 (14.28) 38 (20.87) <10% CVD event risk – reference variable, CVD: Cardiovascular disease, *P value was statistically significant Among participants, nearly 47% of them had ˂10% of CVD risk whereas nearly 6% had more than 40% of CVD [Figure 1]. The prevalence of >10% CVD risk significantly enhanced with age with greater prevalence among the age group of 61-70 years compared to the other age groups (p <0.05) [Table 1]. The prevalence of >10% CVD risk was observed to be more (p<0.05) among non-vegetarians, smokers, alcoholics, and diabetics compared to their counterparts. [Table 2]. Figure 1: Prevalence Of Cardiovascular Event Risk Among Study Participants In the current study, the risk for developing >10% fatal or nonfatal cardiovascular event was reported to be more among the age group of 61–70 years [Odds ratio = 13.6, p<0.05) compared to other age groups. It was also shown that the risk for developing >10% fatal or nonfatal cardiovascular event for the type 2 diabetic participants (Odds ratio = 5.126, p<0.05) was greater than nondiabetic participants.

The present cross sectional study documented that more than half of the participants had more than 10% risk of developing CVD events. This study corroborates with the study done by Tamilamudhan Manivannan et al. [10] where the reported percentage of participants was around 55%. The findings were comparable to other studies of south India with low percentages of participants with more than 10% risk of CVD events [11, 12]. This could be attributed to variation in the target population in other studies as they were executed among general population whereas the current study was carried out among hypertensive patients. In both the studies, almost half of the study participants were less than 50 years, but in our study, the percentage is less.

In this study, our analysis revealed that older age, smoking habits, and type 2 diabetes significantly raised cardiovascular disease (CVD) risk, aligning with established evidence linking aging to higher cardiac event rates. Af Geijerstam P et al. [13] and Mengozzi et al. [14] reported similar findings in their study. Gender serves as an identified key predisposing factor for cardiovascular events [13, 14]. Research by Kundu et al. [15] reveals that males suffer a more burden of premature cardiovascular mortality than females [15]. Additionally, multi-nation nationally representative data evaluated by Otgontuya et al. [16] shows that a greater percentage of males encounter moderate or high cardiovascular disease (CVD) risk compared to females. In line with this, the initial bivariate analysis in the current study reported a high risk of CVD events in males versus females, though this variance lacks statistical significance; on the contrary, controlling for additional variables via multiple logistic regression shifts the pattern to indicate a greater yet still statistically non-significant risk of CVD events among females.

The existing literature suggests that alcohol consumption advances cardiovascular event risks [7-10]. Our study analysis stated a greater incidence of cardiovascular events among alcohol drinkers. This could be compared with a Rural Chennai Study [10] and Nepal study [17] where alcohol consumption showed no significant relationship with a more than 10% cardiovascular event risk [15]. This lack of correlation potentially attributable to present study's specific criteria defining alcoholics as participants consuming alcohol for a minimum of twelve months. Regarding the work patterns, the current literature validates a significant danger of fatal and non-fatal cardiovascular events among extremely sedentary people, our study findings did not find any significant link between sedentary employment and cardiovascular event risks, mirroring findings from a rural community study in Nepal [17]—a difference might be due to differing operational definitions of physical activity.

The study reported few limitations. Because this study relied on a limited period data alongside a constrained sample size, the findings cannot be generalized to the wider population of Maharashtra. Subsequently, further research integrating significantly greater sample populations and more robust sampling techniques are necessary to measure cardiovascular disease (CVD) event risk with a high degree of precision.

The present study findings indicate a considerable prevalence of cardiovascular event risk among hypertensive patients residing in rural regions of Pune District of Maharashtra. Applying the WHO–ISH charts can serve as an effective approach for assessing cardiovascular disease event risk in these hypertensive individuals. Executing this approach ensures that diligent blood pressure management, comprehensive screening for co-morbidities, and steady medical follow-ups are enforced to avert fatal cardiovascular events among these hypertensive patients.