India Hypertension Control Initiative, a high impact and low-cost solution

It is estimated that at least one in four adults in India has hypertension ¹, but, only about 12% of them have their blood pressure under control ².

India has set a target of 25% relative reduction in the prevalence of hypertension (raised blood pressure) by 2025³. To achieve this, it is important to fast-track access to treatment services by strengthening interventions such as the India Hypertension Control Initiative (IHCI). IHCI is a multi-partner initiative of the Government of India’s Ministry of Health & Family Welfare, Indian Council of Medical Research (ICMR), WHO Country Office for India (WHO India), and Resolve to Save Lives (Technical partner).

Uncontrolled blood pressure is one of the main risk factors for cardiovascular diseases (CVDs) such as heart attacks and stroke and globally are the most common cause of death and disease. CVDs are also responsible for one-third of total deaths in India ⁴. Of the estimated 220 million people in India living with hypertension, only 12% have their blood pressure under control².

“Hypertension kills more adults than any other cause. Treatment of people with high risk of CVD is one of the best buys recommended by the WHO and scaling hypertension treatment and control can save millions of lives in the next decade,” says Dr Roderico H. Ofrin, WHO Representative to India.

A report on the progress made under IHCI was released on 9 May 2022 during a meeting organized by ICMR to discuss mainstreaming IHCI strategies under India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke.

IHCI annual progress report released in New Delhi by officials from WHO, ICMR, Ministry of Health & Family Welfare, Directorate General of Health Services, National Health Systems Resource Centre on 9 May 2022.© WHO India

The success of IHCI Phase I led to its expansion from 25 to 100 districts across the country. By April 2022, more than 2.5 million patients with hypertension have been enrolled in over 15 000 health facilities.

Of a million patients registered in the 4505 health facilities till December 2020, about 740 000 were under care between April 2020 – March 2021.
Nearly 47% of the registered patients under care had blood pressure under control during the most recent visit in the first quarter of 2021.

The blood pressure control was highest (55%) at Health and Wellness Centres (HWC), second highest (48%) at primary health care (PHC), followed by 44% in hospitals and 37% in Community Health Centre (CHC) facilities.

Under IHCI, a team of Cardio-Vascular Health Officers (CVHOs) and Senior Treatment Supervisors (STSs) from WHO supports the state governments in developing and adopting treatment protocols; forecasting and procurement of anti-hypertension medicines; building capacity of health care providers; monitoring patients through effective information systems including digital apps like “Simple app”.

CVHO supporting and building capacity of staff in a Health & Wellness Centre. © WHO India

Using standard treatment protocols and drug consumption from the IHCI, the average cost for treating hypertension patients treated in the public sector could be as low as Rs 200 per patient per year.

The strategies and lessons learnt have been used to include diabetes management under the IHCI, and to improve quality and scale the interventions to other districts.

IHCI reports and e-newsletters

IHCI training manuals and other information materials - Read more

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¹ Geldsetzer P, Manne‐Goehler J, Theilmann M, et al. Diabetes and hypertension in India: a nationally representative study of 1.3 million adults. JAMA Intern Med. 2018;178(3):363‐372

² Prenissl J, Manne‐Goehler J, Jaacks LM, et al. Hypertension screening, awareness, treatment, and control in India: a nationally representative cross‐sectional study among individuals aged 15 to 49 years. PLoS Med. 2019;16(5):e1002801

³ National Action Plan and Monitoring Framework for Prevention and Control of Non-Communicable Diseases (NCDs) in India. MoHFW.

⁴ Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, Mohan V, Prabhakaran D, Ravindran RD, Reddy KS. Chronic diseases and injuries in India.Lancet. 2011; 377:413–428. doi: 10.1016/S0140-6736(10)61188-9