Ivory Tower: One in four adults has high blood pressure, says ICMR

Cardiovascular diseases, which include heart attacks and strokes, cause one-third of deaths in India, the Indian Council of Medical Research (ICMR) has said.

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The apex body in India for the formulation, coordination and promotion of biomedical research, which is one of the oldest and largest medical research bodies in the world, has found that that uncontrolled blood pressure is one of the main risk factors for cardiovascular disease.

In India, one in four adults has high blood pressure. Among people with high blood pressure, approximately half have been diagnosed by a health provider and only 1 in 10 have achieved blood pressure control, a recent study by the ICMR under the Indian Hypertension Control Initiative (IHCI) has revealed. To address the high burden of mortality due to non-communicable diseases (NCDs), the Centre had adopted the “25 by 25” goal, which aims to reduce premature mortality due to the NCDs by 25 per cent by 2025.

Sharing details, a senior functionary of the ICMR told The Tribune that one of the nine voluntary targets includes reducing the prevalence of high blood pressure by 25 per cent by 2025. Based on the successful implementation of the strategies and initial progress of the project, the task force project on ‘IHCI-Phase II’ was initiated to expand the project to 100 districts across the country in August 2019 for five years. Currently, the IHCI is being implemented in more than 153 districts across 27 states in the country.

She said that overall, the IHCI has registered 54 lakh patients with hypertension and 26 lakh patient with diabetes. The blood pressure control rate ranges from 15 per cent to 62 per cent across the states. The best practices of the IHCI have been incorporated in the National Programme for Prevention and Control of Non-communicable Diseases (NP-NCD) and it has been taken up in the national NCD programme.

“The IHCI data has been successfully transferred to the NP-NCD portal,” the ICMR official divulged, adding that as per the latest NP-NCD portal, 4.56 crore patients with hypertension and diabetes are under treatment in the country.

WHAT IS IHCI

The IHCI is a multi-partner initiative in the Ministry of Health and Family Welfare, the ICMR, State Health departments, and the World Health Organisation (WHO), which began in November 2017, to improve blood pressure control in public health facilities. Resolve to Save Lives (RTSL) was a technical partner. The programme was implemented in 25 districts of the five Indian states under Phase I. Ludhiana in Punjab was among them.

FIVE KEY STRATEGIES

The five key programmatic strategies of the IHCI were to ensure the use of standard drug and dose-specific algorithms for hypertension management at primary health care facilities agreed upon by various stakeholders at the state level, uninterrupted availability of protocol medications and diagnostics fixed the gaps in the procurement and supply chain system, team-based care in public health facilities improved the quality of care and patient retention, patient-centered care closer to home ensures a minimum of 30-day medications dispensed at the health and wellness centers (HWCs)/sub-centers (SCs), and cohort monitoring using a robust information system using simple indicators of coverage (patient registration) and quality (blood pressure control rate) ensures the coverage and quality of the programme.

SERIOUS, GROWING HEALTH ISSUE

Hypertension is a serious and growing health issue in India. There are an estimated 20 crore adults with hypertension, of whom approximately only 2 crore have it under control. The Government of India has adopted the “25 by 25” goal, which aims to reduce premature mortality due to non-communicable diseases (NCDs) by 25 per cent by 2025. One of the nine voluntary targets includes reducing the prevalence of high BP by 25 per cent by 2025.

AIM TO ACCELERATE NCD TARGET

The IHCI aims to accelerate progress towards the Government of India’s NCD target by supplementing and intensifying evidence-based strategies to strengthen the building blocks of hypertension management and control.

HOW IT WORKS

The IHCI emphasises decentralised patient-centric care to boost hypertension control in public healthcare facilities. The study documented the decentralisation process, enrolment pattern by facility type and treatment outcomes.

METHOD

The study detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the WHO health system pillar framework. It reviewed hypertension treatment records in the public facilities, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care.

RESULT

The decentralisation process involved training, treatment protocol provision, supervision and monitoring. Among 3,94,038 individuals registered with hypertension from 2018-2021, almost 69 per cent were under care in 2022. Nearly half of those under care (1,29,720 of 2,73,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14 per cent), community health centres (20 per cent), and primary health centres (24 per cent) were decentralised to HWCs. Overall BP control rose from 20 per cent (4,004 of 20,347) in 2019 to 58 per cent (1,57,595 of 2,73,355) in 2022, while missed visits decreased from 61 per cent (12,394 of 20,347) in 2019 to 26 per cent (70,894 of 273,355) in 2022. This trend was consistent in Punjab and Maharashtra. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types.

RECOMMENDATION

The study documented an increase in decentralised access to hypertension treatment and improved treatment outcomes over four years. It recommended operationalising hypertension care at the HWCs to other districts in India to improve BP control.

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