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WHO hypertension report reveals 4.6 million lives in India can be saved by 2040 with better control. Are you at risk?

At least 4.6 million deaths in India can be prevented by 2040 if half its hypertensive population controls its blood pressure, according to the first-ever report released by WHO on the global impact of hypertension. It estimates that 31 per cent of the country’s population or 188.3 million people are living with the condition currently.

Considering high blood pressure (140/90 mmHg or higher) leads to stroke, heart attack, heart failure, kidney damage and many other health problems and is preventable, the WHO flags problem areas. Only 37 per cent of Indians with hypertension are diagnosed and only 30 per cent get treated. At present, only 15 per cent of those with hypertension in the country have it under control, the report says. In fact, it adds, more than half of all the deaths in the country (52 per cent) due to cardiovascular diseases such as heart attack can be attributed to elevated blood pressure.


With Indians more prone to developing heart diseases a decade earlier than other populations and young people reporting heart attacks earlier, the WHO findings are significant. “Uncontrolled hypertension damages blood vessels and organs and this impact increases with prolonged exposure to heart stress. So young people are at a high risk of future adverse health events if their hypertension is undetected or uncontrolled. Given the high levels of diabetes (101 million) and pre-diabetes (137 million) in our population, uncontrolled hypertension can ignite a wildfire of health complications. However, effective control, by changing our living habits and using medicines additionally when needed, can greatly avert these risks. The WHO report is a timely wake-up call for urgent action,” says Dr K Srinath Reddy, distinguished professor, Public Health Foundation of India (PHFI). “Detection of hypertension also opens the door to investigation, detection and management of other abnormalities like deranged blood sugar, blood lipids and obesity, besides revealing possible causes of ‘secondary’ hypertension,” he adds.

While India has decided to put 75 million patients with hypertension or diabetes on standard care by 2025, a fact lauded by the WHO, the report shows that prevention, early detection and effective management of hypertension are among the most cost-effective interventions in health care. Globally, hypertension affects one in three adults or about 1.3 billion people. The report collected data from the 30 to 79 age group.


The primary triggers for hypertension in India have been listed as high salt intake, tobacco use, obesity, alcohol consumption and lack of physical exercise. In fact, the report flagged tobacco use (28 per cent) and physical inactivity (34 per cent) as the two most potent triggers in India.


Dr V Mohan, Chairman, Diabetes Specialities Centre, Chennai, has a first-hand experience dealing with unaware patients. “In rural India, a majority of the people still do not know much about the condition. Even if a screening camp is going on, they might not go in thinking that it is meant for those with hypertension. They might not even consider that they could have the condition because it is largely asymptomatic. That is the reason many do not get treatment despite diagnosis,” he says.


Many get diagnosed only when they are admitted to a hospital for some other treatment or when they land up with allied complications. “What is of more concern, however, is that even diagnosed people are reluctant to take these medicines and follow dosage. There are no symptoms really until there are complications — the heart gets damaged or the kidney fails. And, this damage cannot be reversed,” says Dr Rakesh Yadav, professor of cardiology from the All India Institute of Medical Sciences.


The report takes a look at the India Hypertension Control Initiative (IHCI), a government initiative to screen people and put them on hypertension treatment at their local health centres, that has now enrolled 5.8 million people with hypertension from 27 states. It flags issues with procuring the blood pressure medicine that the programme initially faced. This led to people not returning to the centres for treatment. The situation, however, improved by 2020. “By 2020, the IHCI had ensured that more than 70 per cent of health care facilities had ensured one month’s stock of the protocol medicines, and fewer than 10 per cent had experienced stock-outs,” the report says.

For instance, the procurement of amlodipine over four years showed a visible increase. In Punjab, from 5.1 million tablets in 2018-19 the numbers rose to 36 million in 2020-2021. Likewise from 12 million in Madhya Pradesh to 37 million, in Kerala from 43 million to 67 million, in Maharashtra from 23 to 143 million and in Telangana from 44 million to 209 million. With an adequate and uninterrupted availability of drugs, it was possible to decentralise the programme to 18,000+ Ayushman Bharat health and wellness Centres for improved access to care, the report says.


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Dr Yadav is all for early age screening, in the 20s or early 30s. “All markers being okay, continue similar screening every ten years and every five years after you turn 50. Continue medication on diagnosis. This is essential for preventing further damage. Monitoring is equally important as these days, you can get a good digital blood pressure monitor for Rs 800 to 900,” says Dr Yadav.

Dr Reddy advocates promotion of dietary approaches that help “people to reduce salt in food and increase consumption of fruit and vegetables (which contain blood pressure lowering potassium). Alcohol consumption should be avoided or greatly reduced, as it precipitates or perpetuates hypertension and makes effective control very difficult. Physical activity, good sleeping habits, reduced exposure to air pollution will help lower blood pressure, as will stress coping methods like yoga, meditation and music.”

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Existing health systems, feels Dr Reddy, must be geared up for early detection in primary care settings. “Technology enabled frontline health workers, like ASHAs and ANMs, can be very effective in early detection and long-term management of hypertension. Opportunistic screening, where people going for some other evaluation are mandatorily checked for blood pressure, can work,” he says. Dr V Mohan, Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai, highlights an implementable model like the one in Tamil Nadu where health workers go door-to-door to screen people. “The aim is to reach towards the rule of 80 — meaning 80 per cent of all hypertensives get diagnosed, 80 per cent of those diagnosed start treatment, and 80 per cent of those who start treatment are able to keep their BP in check,” he adds.

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