The IHCI project has demonstrated that blood pressure treatment and control are feasible in primary care settings in diverse health systems across various States in India.

India Hypertension Control Initiative (IHCI)

• It is a multi-partner initiative involving the Indian Council of Medical Research, WHO-India, Ministry of Health and Family Welfare, and State governments.
• It aims to improve blood pressure control for people with hypertension.
• The project initiated in 26 districts in 2018 has expanded to more than 100 districts by 2022.
• More than two million patients were started on treatment and tracked to see whether they achieved BP control.

The project was built on five scalable strategies:

1. Simple treatment protocol with three drugs was selected in consultation with the experts and non-communicable disease programme managers.
2. Supply chain was strengthened to ensure the availability of adequate antihypertensive drugs.
3. Patient-centric approaches were followed, such as refills for at least 30 days and assigning the patients to the closest primary health centre or health wellness centre to make follow-up easier.
4. The focus was on building capacity of all health staff and sharing tasks such as BP measurement, documentation, and follow-up.
5. There was minimal documentation using either paper-based or digital tools to track follow-up and BP control.

Prevalence of hypertension in India

• Cardiovascular diseases (CVD) are the leading cause of death among adults in India.
• One of the major drivers of heart attack and stroke is untreated high blood pressure or hypertension.
• Hypertension is a silent killer as most patients do not have any symptoms.
• India has more than 200 million people with hypertension, and only 14.5% of individuals with hypertension are on treatment.

Success of IHCI

• Blood pressure treatment and control were feasibly controlled in primary care settings in diverse health systems across various States in India.
• Before IHCI, many patients travelled to higher-level facilities such as community health centres (block level) or district hospitals in the public sector for hypertension treatment.
• Over three years, all levels of health staff at the primary health centres and health wellness centres were trained to provide treatment and follow-up services for hypertension.
• Nearly half (47%) of the patients under care achieved blood pressure control.
• The BP control among people enrolled in treatment was 48% at primary health centres and 55% at the health wellness centres.

Contributing to its success: A data-driven approach

• One of the unique contributions of the project was a data-driven approach to improving care and overall programme management.
• The list of people who did not return for treatment was generated through a digital system or on paper by the nurse/health workers.
• Patients were reminded either over the phone or by home visit (if feasible).
• This strategy motivated a large number of patients to continue treatment.
• In addition, programme managers reviewed aggregate data at the district and State levels to assess the performance of facilities in terms of follow-up and BP control.
• Patients were provided generic antihypertensive drugs costing only ₹200 per year.
• In addition, E-Sanjeevani, a telemedicine initiative, facilitated teleconsultations.

Back2Basics: Hypertension

• Hypertension also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
• High blood pressure usually does not cause symptoms.
• Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.
• High blood pressure is classified as primary (essential) hypertension or secondary hypertension.
• For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.

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