It is estimated that one in four adults in India has hypertension. Globally, 1.13 billion people suffer from this condition.
Background
Hypertension is defined as high or raised blood pressure, higher the pressure, harder the heart has to pump the blood (Blood pressure ≥140 mm of Hg systolic and/or ≥90 mm of Hg diastolic and/or as current use of antihypertensive medication). Hypertension also increases the risk of heart, kidney, and brain diseases. It is one of the major causes of premature death in people.
Hypertension and Low and middle income countries
Like many diseases and medical conditions, hypertension and the burden of it is felt heavy among low and middle income countries. Aletta E. Schutte, et. al, (2021), writes, there is by far a high uncontrolled hypertension in low and middle income countries. There is a lack of screening and undiagnosed patients along with lack of treatment, uncontrolled hypertension, and an unmet need of services related to hypertension in LMICs. High out of pocket expenditure involved in tests, medications, drugs, hospital costs, transportation and food are also leading to catastrophic health expenditure in LMICs. Another study by the Lancet journal, globally, in 2019 countries namely, South Korea, Canada and Iceland have the highest rates in terms of control and treatment of hypertension. Thus, improvements in detection, treatment and control is varied substantially in
mhealth or mobile health can constitute as a major change driver in sensitize people to become aware of their health challenges. In this era of mobile world, people belonging every class has a good working mobile internet connection (2.6 billion users in LMICs). mhealth technology can thus identify, track, and follow-up with the patients diagnosed with hypertension. According to one systematic review, published in the year 2020, mhealth interventions have successfully able to reduce Systolic Blood Pressure by 2.99 mm Hg.
Indian Hypertension Control Initiative, a program of Ministry of Health and family welfare
An estimated 260 million people over the age of 18 years have hypertension in India. In 2017, Ministry of Health & Family Welfare in collaboration with Indian Council of Medical Research and the World Health Organization have started an initiative, " Indian Hypertension Control Initiative" to help India achieve its NCD goals. The aim was to introduce and act upon evidence based strategies towards strengthening the building blocks of hypertension and to achieve 25% reduction in raised blood pressure (BP) by the year 2025.
In India, where one in every four adults have hypertension problem, only 12% of them have their blood pressure control.
As per the current statistics, the program is implemented in 21 States and 105 districts, 15703 health care facilities with 10 and 25 lakh diabetes & hypertension patients enrolled in health care facilities.
One of the primary aims of the program is to treat patients with high risk of Cardio Vascular Diseases. According to one of the progress brief of the program, it was documented that managing BP for 2.5 crore individual can prevent up to 5 lakh deaths due to CVD in the next 10 years.
The key intervention strategies of the program can be seen as: protocols, team care & task sharing, medication supply, patient centered care, and information system. The services include, (Simple App) screening of every adult for hypertension in facilities, efficient patient flow, flow of services from District hospitals to CHCs, CHCs to PHCs and PHCs to sub centres, stock of drugs at lowest health facilities, transport facilities, etc.
This patient centered application was designed to manage hypertension problems in patients and also includes tele medicines for delivering services at community level. For this, approximately 1200 health care workers were trained to use this application to access patient's profile, request teleconsultation with medical officer through a text or a WhatsApp message. After the consultation with the patient and the health care worker, the medical officer sends an e-prescription.
Blood Pressure control was highest in the Health and Wellness centres (55%), followed by Primary Health centres (48%) followed by Community Health centres (37%).
However, the future demands from the program is to increase the number of registration, to work upon the missed visits by the patients, a monthly review, improve the BP control rate, availability of drugs, engage more private players, etc.
Evidently, India has a huge burden in terms of treating non-communicable diseases. High Blood Pressure (silent killer) or hypertension is one of the major risk factors contributing to cardiovascular diseases in India. Still many people are unaware of their health condition and its largely left untreated and undiagnosed. Improving the coverage for effective treatment of patients should be scaled up. Hypertension prevention and control can make a significant contribution even to Sustainable Development Goals, 3.4 on Non-communicable diseases.
