India records success with BP treatment and control

India’s hypertension control initiative, launched in 2018, has expanded to over 100 districts

India’s hypertension control initiative, launched in 2018, has expanded to over 100 districts

Cardiovascular disease (CVD) is the leading cause of death among adults in India. High blood pressure or high blood pressure is one of the main drivers of heart attacks and strokes. Hypertension is a silent killer because most patients have no symptoms.

India has more than 200 million people with hypertension, and only 14.5% of people with hypertension are on treatment. Unlike many other illnesses, hypertension is easy to diagnose and can be treated with inexpensive generic drugs.

India Hypertension Control Initiative (IHCI) is a multi-partner initiative involving Indian Council of Medical Research, WHO-India, Ministry of Health and Family Welfare and state governments to improve blood pressure control people with hypertension. The project started in 26 districts in 2018 has expanded to more than 100 districts by 2022. More than two million patients have been put on treatment and followed up to see if they have achieved blood pressure control.

The project demonstrated that blood pressure treatment and control is feasible in primary care facilities of various health systems in various states of India. Prior to IHCI, many patients went to higher level facilities such as community health centers (block level) or public sector district hospitals for treatment of hypertension. For three years, all levels of health personnel from primary health centers and health and wellness centers have been trained to provide hypertension treatment and monitoring services.

Five scalable strategies

Nearly half (47%) of treated patients achieved blood pressure control. BP control among those enrolled in treatment was 48% at primary health centers and 55% at health and wellness centers. The most encouraging finding was that BP control in primary care settings was higher than in hospitals. The availability of drugs in peripheral facilities made it easier for the patient to continue treatment, thereby improving BP control.

The project was built on five evolving strategies: First, a simple three-drug treatment protocol was selected in consultation with experts and non-communicable disease program managers. Second, the supply chain has been strengthened to ensure the availability of adequate antihypertensive drugs. Third, patient-centered approaches were followed, such as refills for at least 30 days and referral of patients to the nearest primary health center or wellness center to facilitate follow-up. Fourth, emphasis was placed on building the capacity of all health personnel and sharing tasks such as BP measurement, documentation and monitoring. Finally, there was minimal documentation using paper or digital tools to track BP monitoring and control.

Data-driven approach

One of the unique contributions of the project was a data-driven approach to improving care and overall program management. The list of people who did not return for treatment was generated digitally or on paper by the nurses/health workers. Patients were called back either by telephone or by home visit (if possible). This strategy has motivated a large number of patients to continue treatment. In addition, program managers reviewed aggregated data at the district and state level to assess facility performance in terms of BP monitoring and control.

Scaling up hypertension treatment is feasible given the enablers in India’s healthcare system. When purchased on a large scale, generic antihypertensive drugs cost only ₹200 per patient per year.

India has an extensive network of primary health centers where doctors and nurses can be trained to diagnose and treat hypertension.

Health and wellness centers under Ayushman Bharat Yojna have specially trained nurses who can measure blood pressure and provide refills for patients initiated into treatment by doctors from the higher health facility.

Additionally, E-Sanjeevani, a telemedicine initiative, facilitates teleconsultations.

Make progress

Since 2018, the project team has been working hand-in-hand with state health departments to strengthen the hypertension component as part of ongoing initiatives for the control of non-communicable diseases. Based on the positive experience, several states have already begun to implement the strategies beyond the project districts.

We face a few challenges to reduce the treatment gap. Many people with hypertension are unaware of their high blood pressure. All health facilities can measure BP at the point of entry for people who visit the doctor for any health problem. This strategy, also known as opportunistic screening, does not require additional resources.

The availability of good quality blood pressure monitors is a prerequisite for accurate blood pressure measurement. Extended refills of up to 60 days can reduce visits to health facilities.

One of the challenges is the involvement of the private sector, where a large number of people with hypertension currently seek treatment. We must overcome the challenges to ensure early detection and treatment of hypertension to reduce preventable death and disability from heart attacks, strokes and chronic kidney disease.

( Prabhdeep Kaur is Senior Scientist and Division Head of NCD, ICMR-National Institute of Epidemiology, Chennai, and a member of IHCI team. [email protected])

About Antoine L. Cassell

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