Silent killer: On hypertension and the first WHO report on the subject

India must get more people to keep blood pressure under control

Globally, hypertension affects one in three individuals and four out of five do not have it adequately controlled, according to the first World Health Organization (WHO) report on hypertension released on September 19. It is a grim reminder that countries have done little to keep the biggest risk factor for death and disability under check despite the easy availability of inexpensive medicines. Uncontrolled blood pressure (over 140/90) is a main risk factor for cardiovascular diseases such as heart attacks and stroke , and the most common cause of disease and death. It is important to note that health risks associated with hypertension do not begin at over 140/90. Instead, they operate in a continuum even below what is classified as clinical hypertension, especially in people who are diabetic, are obese , and those who consume tobacco and alcohol. Hence, reports on hypertension levels in the population underestimate the cumulative risk of high blood pressure. In the WHO report that relies on 2019 data, 188 million Indians adults aged 30-79 years have hypertension. Of them, the condition has been diagnosed only in 37%, 30% are treated and a meagre 15% of people have hypertension under control. Women appear to be marginally better than men in having the condition diagnosed, treated and controlled. Based on sketchy data from parts of India, stroke incidence was found to be 108-172 per 1,00,000 people per year and the one-month case fatality rate was 18%-42%, as per a February 2022 study. In the Global Burden of Disease report, in 2019, heart attack was the leading cause of death and disability in India.

Studies have shown that excess salt consumption (over five grams a day) is responsible for 17%-30% of hypertension. While member States are required to achieve a 30% relative reduction in mean population intake of salt by 2025, India is yet to implement many components of WHO’s prescription to cut-down salt intake. A study in four Indian States published in 2021 found high salt and sugar content in packaged food items. Making front-of-pack nutrition labelling mandatory, encouraging reformulation of foods to cut down salt, and raising awareness in people to reduce salt intake should be urgently undertaken . India has, however, done well in improving blood pressure control in people with hypertension through the novel India Hypertension Control Initiative (IHCI). Launched in 2018, the IHCI has successfully enrolled 5.8 million hypertensive patients for treatment in 27 States, as of June 2023. Importantly, 48% of patients enrolled at primary health centres and 55% at health wellness centres achieved blood pressure control as of March 2021. It is now important to greatly increase the number of hypertensive people on treatment and keep blood pressure under control.