Follow-up visits had one of the lowest rate in Punjab, and in the patient population that did adhere to treatment, BP control was only about 54.7 per cent. (Representational Image) India Hypertension Control Initiative (IHCI), a multi-partner initiative led by the Indian Council of Research (ICMR) has been successful in improving blood pressure control rates across four states. While Punjab has seen improvement, it continues to have one of the poorest control rates combined with one of the highest prevalence in the country.
This study is based on patients who visited IHCI sites in four states and were observed for six months. Overall 64 per cent of patients had various stages of uncontrolled hypertension when they registered. In Punjab 89 per cent of patients who registered at selected IHCI sites had raised blood pressure and only 30 per cent of them had been previously diagnosed.
The study found that treatment adherence is currently one of the biggest problem areas in arresting the hypertension epidemic. Nearly half of the patients registered in the IHCI sentinel sites did not return for scheduled follow-up visits.
Follow-up visits had one of the lowest rate in Punjab, and in the patient population that did adhere to treatment, BP control was only about 54.7 per cent.
Highlighting the alarming prevalence of hypertension in the state of Punjab, Dr Sonu Goel, Professor, Dept of Community Medicine and School of Public Health, PGIMER said, “In the state of Punjab more than 35.7 per cent of the population has high blood pressure, which is much higher than the national average of 25.3 per cent. Most people are unaware of their blood pressure levels, particularly the younger population.
He further said, “We consider this public health concern a priority and have been supporting the state government to boost treatment at the primary care centres. During the lockdown Punjab stepped up to ensure people with blood pressure continued to be diagnosed and treated through seamless delivery of telemedicine. This paper draws attention to the fact that we must deliver hypertension treatment close to people’s homes, even their doorsteps if possible.”
To scale the interventions and gradually integrate into the national program, Phase 2 of the project was launched in July 2019. “This is the right step forward. The results received from the IHCI study can only help us reduce the number of cardiovascular deaths in the country,” says Ashim Sanyal, COO of Consumer VOICE NGO.
Highlighting the importance of follow-up visit, Dr SS Sodhi, cardiologist and President, IMA, Mohali said that patient follow up for hypertension is the current challenge. Dr Sodhi says the need is to think creatively and innovate health systems to ensure that once patients have left the district or block hospital, diagnosed as hypertensive, they return for a follow-up and continue their medication.
“One of the innovations could be extended prescription for hypertension, which will allow the patients to have a steady supply of BP medicines. The state government has already issued an order recommending this.”
The study also pointed out that due to overcrowding of district and block hospitals and a high burden of patients with comorbidities, hypertension may be better managed in primary health care settings, closer to patients’ homes. Punjab’s well-organised health wellness centres have been able to screen over 6.8 lakhs individuals in the past five months.
IHCI aims to strengthen the government’s programme by strengthening the management of diagnosed hypertension in primary health care settings to improve India’s hypertension management and control.
The study demonstrated substantial blood pressure control improvements as a result of the five-step intervention designed by IHCI following WHO HEARTS technical package adapted to the Indian context.