Hypertension (high blood pressure) is the most common preventable risk factor for heart attacks and strokes, affecting more than 200 million adults in India. Despite the treatment being safe, effective, and low cost, only 12 percent of people living with hypertension in India have their blood pressure under control. As a result, hypertension contributes to approximately 1.5 million deaths annually in the country, or one death every 21 seconds. Because most patients have no symptoms (hypertension is known as a silent killer), less than a third of people with hypertension in India are even aware of their condition. 

 

As part of its commitment to preventing and controlling NCDs, the Government of India has set a target for a 25% reduction in high blood pressure by 2025. To achieve this target, it is critical to adopt a comprehensive approach integrating hypertension treatment into the larger framework of comprehensive primary healthcare. This approach encompasses promoting healthy lifestyles and improving access to treatment till the last mile.

 

The Ministry of Health and Family Welfare (MoHFW) has implemented several initiatives to address the country's rising hypertension burden. Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), the world's most extensive population-based screening program for common NCDs allows screening of persons with hypertension, diabetes and common cancers and their referral to public health facilities for diagnosis and treatment. This program is complemented by the India Hypertension Control Initiative (IHCI), a joint initiative of the MoHFW, Indian Council of Medical Research, the World Health Organization, and technical partner Resolve to Save Lives (RTSL), aimed at improving treatment and control of hypertension and diabetes at the primary health level. Launched in 2017, IHCI has become the largest hypertension control program globally based on WHO's HEARTS strategies and was recently awarded the 2022 United Nations Interagency Task Force and the World Health Organization Special Programme on Primary Health Care Award.

 

RTSL as the technical partner to IHCI, has contributed to the success of the national program through the adoption of crucial IHCI strategies such as a) standardized, evidence-based treatment protocols for hypertension and diabetes, b) uninterrupted availability of hypertension and diabetes medications at all public health facilities c) implementation of team-based care and patient-centered services d) decentralization of hypertension and diabetes services to the HWCs and e) development of a robust information system for cohort monitoring. Strengthening hypertension services in primary healthcare through IHCI has served as an entry point for the overall strengthening of comprehensive primary healthcare under the Ayushman Bharat Health and Wellness Centre program.  

 

An important strategy in implementing a successful hypertension control program is to ensure accurate blood pressure measurement to diagnose and treat hypertension. This requires using blood pressure monitors that have been clinically validated for accuracy. However, most automated blood pressure measuring devices consumers purchase must be adequately validated, potentially leading to misdiagnosis and mismanagement of hypertension. This is now being adopted in government programs, and high-quality digital blood pressure monitors have made it easy for primary health facilities and community health workers to measure blood pressure accurately. 

 

Accurate blood pressure measurement is the first step towards a longer and healthier life. While lifestyle changes such as reducing salt intake, increasing physical activity, and maintaining a healthy diet are essential, for most patients with hypertension, taking blood pressure medication every day and regular follow-ups with their healthcare provider to ensure blood pressure control is key to avoiding health risks. 

 

World Hypertension Day is observed on 17 May every year to raise awareness and promote hypertension prevention, detection, and control. To achieve the Government of India's ambitious target of reducing high blood pressure, approximately 4.5 crore additional people with hypertension need to get their blood pressure under control by 2025. Several steps have been taken to strengthen the health system in early detection and effective management of hypertension, which will accelerate progress towards achieving the goal of universal health coverage. During its G-20 presidency year, India can also serve as an example for the world, showing how hypertension can be managed effectively with the right policies, investments and implementation strategies, leading to better health outcomes for all.