lipped from: https://www.thehindubusinessline.com/opinion/hypertension-a-silent-threat/article69580471.ece
Policy action with clinical intervention is crucial
Hypertension: Early detection helps | Photo Credit: BrianAJackson
Six years ago, while accompanying my father-in-law to a routine doctor’s visit, I was unexpectedly diagnosed with hypertension. I began low-dose single medication and, later, on the advice of a renowned cardiologist, added a second drug to my regimen. Today, I remain grateful to both physicians — their timely guidance likely prevented more serious consequences.
Hypertension, often dubbed the “silent killer,” typically progresses without symptoms, gradually damaging the heart, brain, and kidneys. Its risk factors include both modifiable behaviours—such as unhealthy diet, physical inactivity, alcohol and tobacco use, and obesity—and non-modifiable factors like age, genetics, and coexisting conditions such as diabetes.
The good news? Hypertension is both preventable and controllable. Even modest reductions in blood pressure can significantly reduce the risk of stroke, ischemic heart disease, and heart failure. A 10 mmHg reduction in systolic blood pressure, for instance, can lower cardiovascular disease risk by 20–25%.
A Global problem with local implications
The World Health Organization’s Global Report on Hypertension (2023) shows that age-standardized hypertension prevalence ranges from 28% in the Western Pacific to 38% in the Eastern Mediterranean. Yet the gap lies in diagnosis and treatment: while 70% of hypertensive individuals are diagnosed in the Americas, this figure drops to just 39% in Southeast Asia. In India, hypertension is an escalating public health concern. According to NFHS-5, 21.3% of women and 24% of men aged 15 and above have elevated blood pressure—rates that are slightly higher in urban than in rural areas.
Traditionally, the “Rule of Halves” suggested that only half of people with hypertension are diagnosed, half of those diagnosed receive treatment, and half of those treated achieve control. However, in India, the reality is even more concerning. A study conducted between 2019 and 2021 revealed that over one in four Indian adults has hypertension. Of these, only one-third are diagnosed, fewer than one in five are treated, and a mere one in twelve have their blood pressure under control.
National Initiatives: Progress and gaps
Recognising this challenge, the Indian government initiated population-based screening for non-communicable diseases (NCDs) in 2016.
A year later, the India Hypertension Control Initiative (IHCI) was launched—a collaboration between the Ministry of Health and Family Welfare (MoHFW), Indian Council of Medical Research (ICMR), WHO India, and Resolve to Save Lives.
The initiative focuses on evidence-based protocols, uninterrupted medicine supply, task-sharing, and decentralized care at the primary health level. All these are components under the globally recognized HEARTS strategy. IHCI demonstrated that ensuring continuum of care for hypertension was operationally feasible.
The IHCI’s best practices have been integrated into the National Programme for Prevention and Control of NCDs (NP-NCD), enabling health systems to track screening, treatment, and control rates down to the village level.
India’s commitment to the ‘75 by 25’ initiative—bringing 75 million individuals with hypertension or diabetes under standard care by 2025—is commendable. With over 71 million patients already enrolled, the target appears achievable. However, enrolment is only the beginning. What truly matters is how many of these patients attain disease control.
Addressing implementation gaps
Over the past year, I’ve visited several states to assess hypertension management. While progress is visible, key implementation gaps remain. A major bottleneck is the delay between screening by Community Health Officers (CHOs) and follow-up by Medical Officers (MOs). Strengthening MO outreach and integrating teleconsultations can bridge this gap.
Availability of essential medicines at Ayushman Arogya Mandirs must be ensured to facilitate continuous care. Equally critical is the widespread use of validated, automated blood pressure monitors, which offer greater accuracy and consistency. Encouraging their adoption in both public and private sectors requires coordinated policy, procurement, and regulatory efforts.
The ABHA (Ayushman Bharat Health Account) ID offers a promising tool for improving continuity of care, enabling patient tracking across facilities. When leveraged effectively, it can reduce loss to follow-up and ensure longitudinal care.
Incentivizing frontline teams to screen individuals aged 30+ for hypertension, diabetes, and common cancers is already underway. Aligning these incentives with outcomes—such as treatment initiation and control rates—and ensuring robust drug procurement can significantly enhance impact.
Emerging evidence suggests that ASHA-led, community-based hypertension control groups are both feasible and scalable — especially in rural areas. With adequate training, remuneration, and supervision, ASHAs can play a transformative role in improving adherence and promoting lifestyle changes. One 2022 study across 18 Indian districts found that nearly 16% of eligible patients missed hypertension diagnoses. Task-sharing — such as involving trainee nurses in routine BP checks—can expand coverage and support universal BP screening for all outpatients.
Towards Simplified and Comprehensive Treatment: Recent international guidance advocates for the use of Fixed Dose Combination (FDC) therapy to improve adherence and streamline hypertension treatment. FDCs—where two or more antihypertensive drugs are combined in a single pill—simplify regimens, reduce pill burden, and improve adherence and outcomes. India’s national guidelines recommend statins for hypertensive patients aged 40 and above who have diabetes, high cholesterol, or high cardiovascular risk. Incorporating statins more comprehensively into standard treatment protocols can further reduce mortality and prevent heart attacks and strokes.
The Role of Public Policy: Clinical interventions alone are not enough. Policy-level actions are equally essential. Increasing excise taxes on tobacco and alcohol, banning their advertisement, reducing salt in processed foods, eliminating trans fats, and promoting healthy eating and physical activity are all evidence-based interventions that can reduce the population burden of hypertension.
A Call to Action: Hypertension may be silent—but its consequences are not. The time to act is now. With the right policies, tools, and public engagement, India can lead the world in developing a cost-effective, scalable model for hypertension control. Clear goals, coordinated efforts, and sustained commitment can help avert millions of preventable deaths.
The writer is former Additional Secretary, Union Ministry of Health
Published on May 15, 2025
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