Why controlling India's spiralling hypertension burden is imperative for the country's overall growth and well-being

Times have changed, medicine has evolved and so have the diseases. While India has seen a decrease in its infectious disease burden, there has been a marked increase in non-communicable diseases such as cardiovascular diseases, cancers and diabetes. These now contribute to nearly 60% of deaths in the country.

One of the major causes of cardiovascular diseases is hypertension, commonly known as high blood pressure. According to the World Health Organization (WHO), hypertension is the leading cause of death globally and kills more people than all infectious diseases combined.

Representational image. Image source: Getty Images.

Cardiovascular diseases like heart attack and strokes contribute to one-third of the total deaths in India. As a practising cardiologist, I see numerous cases of preventable heart attacks and strokes caused by uncontrolled blood pressure. A large proportion of these deaths and illnesses can be prevented if high blood pressure is detected and treated at an early stage.

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It is alarming that 1 in every 4 adults in India, which is almost 20 crore people, suffer from hypertension. Even more alarming is the fact that only half of these people are aware of their condition and only two crore people have their blood pressure under control.

Hypertension left untreated does not only cause illness or death, but it also puts a significant financial burden on the patients and their family. While the treatment of high blood pressure is seemingly simple, it is not an easy task to reach the patients in geographically diverse regions and disparate health systems. Thus, the key to addressing hypertension-related diseases would be creating awareness about monitoring blood pressure and increasing the accessibility of treatment for the patients.

The most cost-effective way to prevent high blood pressure is the constant monitoring of it by healthcare providers. All people above the age of 30 should get their blood pressure checked at least once a year. Once diagnosed early for high blood pressure, patients should seek treatment from their health facility. These generic drugs cost around Rs 200-250 per year. The yearly cost of these drugs is 500 times cheaper than the cost for a cardiac procedure.

State governments should ensure that these drugs are provided in the public healthcare facilities including health and wellness clinics, primary and secondary healthcare centres that are more accessible to patients. This would not only reduce the financial burden on the family of the patient but also on the tertiary care facilities.

Countries like Canada and Thailand have been extremely successful in curbing hypertension-related deaths. These countries have deployed community-based programs focused on high blood pressure detection to facilitate early treatment and avoid cardiovascular diseases. A comprehensive strategy that includes training frontline health workers to monitor blood pressure, providing treatment in primary healthcare centres and raising awareness about the condition was key to the success of these programs. In countries like India where access to tertiary healthcare is relatively low, it is even more important that patients are monitored for blood pressure and get early treatment to avoid cardiovascular diseases.

These diseases have a catastrophic financial implication on patients especially on people from low-income backgrounds. Keeping this in mind, the Government of India has set a target for a 25% reduction in high blood pressure by 2025. To achieve this mammoth task, the government needs to mobilize support from all quarters and stakeholders. With this vision, Indian Council of Medical Research (ICMR) along with WHO-India and Ministry of Health and Family Welfare (MoHFW) has initiated the nation-wide scale-up of the India Hypertension Control Initiative (IHCI).

Since November 2017, has successfully enrolled almost 3 lakh patients with high blood pressure in 25 districts. These patients are constantly being monitored and have been provided treatment for effective blood pressure control. To accelerate the progress toward achieving the 2025 target the program will be expanded to 100 districts across India covering all the states. The project will now cover over 15 crore population over the next four years and prevent deaths from heart attacks, strokes and kidney failure. It will focus on ensuring a continuum of care and give a boost to the ongoing “Ayushman Bharat” program.

The global health community is looking at India whose commitment is unambiguous toward both controlling hypertension and providing quality treatment for it. Hopefully, ICMR, MoHFW and WHO’s IHCI will spearhead the country’s hypertension control - with the project built on the foundations of a collaborative spirit and willingness of each individual to tackle the condition.

Lastly, all of us need to check our blood pressure at least once in a year to know our number and keep it under control.

Professor Balram Bhargava is a renowned cardiologist and is currently the Director-General of the Indian Council of Medical Research (ICMR) and Secretary of India's Department of Health Research.