Central Idea

An analysis of recent National Family Health Survey data, as published in the journal JAMA, has revealed substantial disparities in the prevalence, diagnosis, treatment, and control of hypertension within Indian states and districts.
These disparities underscore the need for targeted and decentralized solutions to address the complexities of hypertension care across the nation.

What is Hypertension?

Hypertension, commonly known as high blood pressure, is a medical condition in which the force of blood against the walls of the arteries is consistently too high.
Blood pressure is measured in millimetres of mercury (mm Hg) and is expressed as two numbers: systolic pressure over diastolic pressure.
The systolic pressure represents the force when the heart contracts, while the diastolic pressure represents the force when the heart is at rest between beats.
Normal blood pressure is typically around 120/80 mm Hg. Hypertension is diagnosed when blood pressure consistently measures at or above 130/80 mm Hg.
However, different organizations may have slightly different guidelines for defining hypertension.

National-Level Observations: The national-level data reveals a common trend – a significant proportion of individuals with hypertension remain undiagnosed, and even among those diagnosed, many do not initiate treatment. Moreover, among those who commence treatment, few achieve adequate blood pressure control.
Inter-State Variation: The study notes that while the prevalence of hypertension is comparable in southern states, it is notably higher than the national average, with 29.9% of the population in these states affected compared to 26.8% nationally.
District-Level Disparities: The study highlights substantial variations within states. For instance, in Meghalaya, the prevalence of hypertension differs significantly across Garo Hills, Jaintia Hills, and Khasi Hills districts, affecting the diagnosis rates. A similar scenario is observed in Karnataka’s Chikmagalur, Shimoga, Udupi, and Chitradurga districts.

Gender and Age: Despite hypertension being more prevalent in men, the data surprisingly reveals that women are more likely to be diagnosed, receive treatment, and achieve blood pressure control.
Socio-Economic Status: Individuals in the wealthiest quintile demonstrate higher rates of prevalence, diagnosis, treatment initiation, and control.
Education Level: Completion of schooling correlates with better rates of diagnosis, treatment, and control compared to those with no schooling or up to Class 11.

Resource Allocation: District-level data can guide state governments in allocating resources efficiently. It helps identify districts with a high prevalence of hypertension that may require increased screening and diagnostic facilities or better accessibility to medicines.
Continuum of Care: Managing chronic conditions like hypertension requires a distinct healthcare approach. Ensuring regular availability of medicines, digitization of records for follow-ups, and the establishment of accessible treatment centers are critical components of an effective continuum of care.

WHO’s Call to Action: The World Health Organization (WHO) emphasizes the potential to avert nearly 4.6 million deaths in India by 2040 if half of hypertensive individuals can control their blood pressure.
Government Initiative: India launched a comprehensive initiative in 2023 to treat 75 million people with hypertension or diabetes by 2025. This endeavor extends beyond infrastructure expansion to active screening, treatment initiation, medication accessibility, and follow-up mechanisms.

India’s quest to bridge the gaps in hypertension care demands a multifaceted approach.
The district-level insights offered by this study can guide policymakers in crafting targeted solutions, ultimately enhancing the continuum of care for hypertension and contributing to better public health outcomes.