Hypertension, or high blood pressure, is a serious health condition that often develops quietly without producing any clear symptoms. However, it considerably increases the risk of heart disease, kidney damage, stroke, and heart failure in affected populations. As a result, it has earned the notorious-moniker of “the silent killer”.
Hypertension is estimated to affect 20 crore adults in India and has long been a serious threat to public health in the country, showing a nearly two-fold increase in prevalence between 1980 and 2010.
Alarmingly, studies have shown that about 90% of thec with hypertension, especially in rural areas, has uncontrolled blood pressure levels. This has largely been due to missed diagnoses, limited access to healthcare, and poor adherence to treatment plans. As a result, India has witnessed a remarkable rise in the rates of heart disease, chronic kidney disease, and stroke. The situation is further complicated by the high rates of diabetes in India, which, when combined with hypertension, nefariously increases the risk of serious health complications. Given the seriousness of this issue, focused interventions to tackle the hypertension epidemic in India have become necessary.
In 2013, the World Health Organisation (WHO) outlined its “25 by 25” target to reduce the risk of non-communicable diseases (NCDs) such as heart disease, diabetes, and cancer by 25% by the year 2025. Recognising the urgent need to address this issue, the Indian Government readily embraced this challenge head-on. Among the nine voluntary goals of India’s mission was a 25% reduction in the prevalence of hypertension by 2025. In response, the Indian Government’s Ministry of Health & Family Welfare, in collaboration with the Indian Council of Medical Research, launched the India Hypertension Control Initiative (IHCI) in 2017. This large-scale public health initiative went hand-in-hand with the efforts of the National Health Policy and Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat Yojana) toward theprevention of premature deaths due to NCDs.
Since its launch in 2017, the IHCI has been working toward providing effective hypertension care to the vulnerable Indian population. Its programme has focused on five key aspects: (i) implementing standardised and effective treatment methods for hypertension control across the country; (ii) ensuring the availability of the required blood pressure control drugs at all public health centres; (iii) creating teams of qualified medical professionals across healthcare centres to monitor blood pressure levels in patients and ensure drug refills; (iv) using technology, health monitoring, and real-time information systems to improve patient care; and (v) prioritising the needs and health of patients across different regions and socioeconomic backgrounds. Seven years on, as we near 2025, the immense progress achieved by India’s central and state governments through the IHCI has brought the country much closer to meeting its hypertension control goals.
The IHCI was initially launched in five states. However, it has since expanded to more than 20,000 healthcare centres in 141 districts across 25 states in the country, reaching a total of 303 million people. Given the varying patterns of hypertension across the country, the IHCI has developed state-specific protocols for hypertension treatment and provided training on the diagnosis, treatment, and monitoring of hypertension to more than 60,000 healthcare professionals. The statistics speak for themselves — between 2018 and 2022, the IHCI enrolled a total of 40 lakh patients with hypertension, i.e., roughly 12.5% of the total adult population-with hypertension. By the first quarter of 2021, nearly half (47%) of the patients under care in this programme had experienced continued blood pressure control. Remarkably, more than 72% of patients who were enrolled in this programme were retained over the long term, contributing to a ten-fold increase in blood pressure control in the enrolled population between 2019 and 2022.
The achievements of the IHCI have extended beyond reductions in blood pressure levels alone. The streamlining of drug treatment protocols by the IHCI has allowed all health centres to maintain drug stocks, improving drug supply, decreasing travel times for patients, and allowing for patient-centred care. Although the COVID-19 pandemic created some unexpected challenges in patient management, the IHCI adapted by pivoting to telephonic consulting calls and community-based drug distribution.
Through such focus at the level of primary care, the IHCI has motivated equitability in hypertension care, especially in underserved populations.These on-ground achievements have also been supplemented by ongoing research aimed at understanding and addressing the barriers to adequate patient care. The impact of the IHCI has garnered international recognition, earning India an award from the United Nations for its initiative to prevent and control NCDs and deliver integrated primary care.
Further demonstrating its commitment to solving India’s hypertension problem, the Union Health Ministry launched its ambitious “75/25” initiative on World Hypertension Day, 2023. As the largest initiative for the management of NCDs in primary health care, this community-based approach is striving to screen and enrol 75 million people with hypertension and diabetes on standard care by 2025.Additionally, the government is using its Sashakt Portal to train 40,000 primary healthcare medical officers and thereby expand access to care across all communities.
Through these endeavours, India has created an impressive tactical roadmap towards overcoming hypertension and the risks it creates. These initiatives are making standardised care available at the grassroots, thereby improving access to essential health services across the country. Additionally, they are strengthening our country’s primary healthcare systems by creating infrastructure for delivering comprehensive care at the community level. Community engagement and awareness are improving, promoting early screening and encouraging lifestyle changes that contribute to better health outcomes. Moreover, through standardised treatment protocols and better access to medications, these initiatives are reducing the financial burden of hypertension care, enabling improved treatment adherence. Real-time data tracking and feedback have created avenues for continuous optimisation, ensuring the more effective management of hypertension. Such systemic improvements in access to screening, diagnosis, and treatment are expected to significantly reduce the rates of uncontrolled hypertension in India, save patients from poor future outcomes such as heart and kidney disease, and prevent premature deaths.
Although this journey to control hypertension has been fraught with difficulty, the Nation has embarked on it with fervour and made significant strides. The destination will soon be in plain sight, but we could get there faster through collaboration between the government, healthcare professionals, researchers, and the private sector. India is now entering an era where public health can truly be considered“public,” shining new rays of hope for a healthier future for the lakhs of Indians living with high blood pressure.
* Padma Shri Dr C. Venkata S. Ram is a globally recognised high blood pressure expert and senior member of the Advisory Board, India Hypertension Control Initiative.