The India Hypertension Control Initiative-early outcomes in 26 districts across five states of India, 2018-2020

Abstract

Hypertension is the leading single preventable risk factor for cardiovascular disease. The India Hypertension Control Initiative (IHCI) project was designed to improve hypertension control in public sector clinics. The project was launched in 2018-2019 in 26 districts across five states: Punjab (5), Madhya Pradesh (3), Kerala (4), Maharashtra (4), and Telangana (10), with five core strategies: standard treatment protocol, reliable supply of free antihypertensive drugs, team-based care, patient-centered care, and an information system to track individual patient treatment and blood pressure control. All states implemented simple treatment protocols with three drugs: a long-acting dihydropyridine calcium channel blocker (amlodipine), angiotensin receptor blocker (telmisartan), and thiazide or a thiazide-like diuretic (hydrochlorothiazide or chlorthalidone). Medication supplies were adequate to support at least one month of treatment. Overall, 570,365 hypertensives were enrolled in 2018-2019; 11% did not have follow-up visits in the most recent 12 months. Clinic-level blood pressure control averaged 43% (range 22-79%) by Jan-March, 2020. The proportion of the estimated people with hypertension who had it controlled and documented in public clinics increased three-fold, albeit from very low levels (1.4-5.0%). The IHCI demonstrated the feasibility of implementing protocol-based hypertension treatment and control supported by a reliable drug supply and accurate information systems at scale in Indian primary health care facilities. Lessons from the IHCI's initial phase will inform plans to improve screening in health care facilities, increase retention in care, and ensure a sustained supply of drugs as part of a nationwide hypertension control program.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1. Availability of antihypertensive drugs in the IHCI project sites, March 2020.

This chart describes the availability of three types of antihypertensive drugs in patient days (≥90 days is optimal) in five Indian states.

Fig. 2

Blood pressure control in various types of facilities in Jan-March, 2020 among a cohort of patients under care in 26 districts in India.

Fig. 3. Community level blood pressure control in IHCI project districts, India.

Estimated community-level BP control in 26 districts among patients under care in Jan-March, 2020 compared to Jan-March, 2019, India. (Estimated hypertensives N = 45,41,994, Number with BP control = 2,18,340 in Jan-March 2020, Number with BP control = 64,704 in Jan-March, 2019).