“75/25” Initiative for Hypertension: Setting Priority for Action

Abstract

The epidemiological shift and the increase in noncommunicable diseases (NCDs) have been of concern in recent times. Hypertension is the primary cause of 10.8% of all fatalities in India. The rapid increase in cardiovascular diseases, spurred on by poor lifestyle choices, is a serious concern. The increasing burden of chronic diseases is shown by data from the Indian Council of Medical Research, which assigns 61.8% of fatalities in 2016 to NCDs. According to data from the World Health Organization, NCDs account for 63% of fatalities in India, whereas CVDs account for 27% of fatalities. The National Program for Prevention and Control of Noncommunicable Diseases and the India Hypertension Control Initiative are the main initiatives being used by India to tackle hypertension and NCDs. Effective management is hampered by low levels of awareness in rural regions, treatment compliance issues, health disparities, and challenges with data collection and monitoring. Government programs and active youth participation are acknowledged as vital components to lower hypertension and pave the road for a healthier future. The Indian government also supports expanding outreach to underserved communities, encouraging better lives, providing telemedicine options, and enhancing data gathering and research for battling hypertension.

Introduction

In the twentieth century, populations all around the globe have experienced significant changes in lifestyle. A multitude of scientific and technological advancements that now impact every aspect of human existence have caused these changes, collectively known as the “epidemiological transition.” Fast food and inactivity have replaced agriculture-driven diets and healthy lifestyles in nearly all human populations. This inactivity has led to changes in disease patterns. ¹

Noncommunicable diseases (NCDs) now account for most fatalities, replacing malnutrition, infectious diseases, and problems with maternal and child health. In 2008, NCDs killed more people than any other cause, accounting for 63% of all mortality globally. ²

The primary cause of death and disability in low-income nations like India is non-communicable diseases, particularly cardiovascular diseases (CVD). According to the most recent report from the Registrar General of India, the major causes of death in India include coronary artery disease (CAD), stroke, as well as other circulatory illnesses. Throughout the nation’s regions, both men and women encounter this. Due to the rapidly increasing incidence of CVD and associated risk factors, the healthcare system is under substantial strain. ³

NCD Status

According to the Indian Council of Medical Research’s (ICMR) 2017 India “State-Level Disease Burden Initiative,” NCDs were responsible for 61.8% of fatalities in India in 2016, up from 37.9% in 1990. The four primary NCDs are diabetes, cancer, chronic respiratory diseases, and CVDs. For each of these diseases, there are four behavioral risk factors: a poor diet, inactivity, use of tobacco and alcohol, and unhealthful eating patterns. ⁴

The World Health Organization’s “NCD-India profile” for 2018 estimates that NCDs cause 63% of all deaths in the nation, with CVDs being the leading cause of overall mortality at 27%, followed by chronic respiratory conditions at 11%, cancers at 9%, diabetes at 3%, and others at 13%. ⁵

The treatment of hypertension and diabetes has been included as output indicators for the first time in the Outcome Budget document of the Union Budget 2023–2024, demonstrating the government’s commitment to expanding care for these conditions. ⁶

Hypertension in India

Of the 1.28 billion people with hypertension worldwide, most (two-thirds) reside in low- and middle-income countries. According to estimates, 46% of people with hypertension are unaware of their condition. Only 42% of people with hypertension receive a diagnosis and treatment. ⁶

In India, at least one in four people is believed to have hypertension, yet only approximately 12% of these individuals have their blood pressure under control. ⁷

Uncontrolled blood pressure is one of the major risk factors for CVDs, which are a major cause of mortality and sickness, including heart attacks, strokes, and kidney failure. ⁸

In addition to being detrimental to an individual’s health, hypertension has a substantial financial impact on the healthcare system. Hospitalization rates and healthcare costs rise as a result of hypertension-related problems, including heart attacks and strokes. A 2-mm drop in systolic blood pressure throughout the entire population is predicted to save 151,000 lives from CAD and 153,000 lives from stroke in India. ⁹

National Response to the Rise in Hypertension

Recognizing the gravity of the situation, the Government of India has developed a comprehensive strategy to address hypertension and its risk factors.

The “India Hypertension Control Initiative (IHCI)” was launched in November 2017 with the purpose of assisting India in achieving its NCD “25 by 25” goal to reduce premature mortality from NCDs by 25% by 2025 by enhancing and increasing the efficacy of evidence-based methods for the treatment and prevention of hypertension. ¹⁰

India Hypertension Control Initiative was a highly effective effort that won praise from the United Nations (UN). It was carried out in 138 districts in 23 states, with over 34 lakh patients with hypertension receiving treatment in public health institutions. ⁸

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) now renamed National Program for Prevention and Control of Noncommunicable Diseases (NP-NCD) was launched in 2010 as part of the National Health Mission (NHM), to combat the ever-growing problem of NCDs. The initiative focuses on enhancing infrastructure, developing human resources, promoting health, and raising awareness for preventing NCDs, detecting them early, managing them, and directing patients to the best level of healthcare institution. ⁴

The NP-NCD is supplemented by IHCI. The program expedites the government’s aims and accomplishments by guaranteeing continuity of treatment and bolstering the ongoing Ayushman Bharat project through the operationalization of more than 1.5 lakh Health and Wellness Centres for tackling menace of NCDs, including hypertension. ¹¹

The treatment of hypertension and diabetes has been included as output indicators for the first time in the Outcome Budget document of the Union Budget 2023–2024, demonstrating the government’s commitment to expanding care for these conditions. ¹²

On World Hypertension Day 2023, the Union Health Ministry unveiled the “75/25” project for the standardization of care for 75 million people with diabetes and hypertension by the year 2025. This initiative demonstrates the government’s commitment to battling NCDs through resource allocation, capacity building, mobilization, and cross-sector collaboration. ¹²

Speaking on World Hypertension Day 2023, Dr V K Paul, Member (Health), NITI Aayog, emphasized the need for Jan Andolan to increase community participation in this effort and the need for nations to cooperate and share successes in the spirit of “One Earth, One Health.” He also stressed the importance of prevention, which includes lifestyle changes such as healthy eating, exercise, and other wellness practices. ¹²

The Ministry of Health and Family Welfare will also rename the gateway that offers population counts, risk assessment, and screening for five common NCDs, including hypertension, diabetes, and oral, breast, and cervical cancers in those over 30 years old. ¹³

India’s Progress So Far

At a UN General Assembly side event held on September 21, 2022, in New York, USA, IHCI received the 2022 UN Interagency Task Force and WHO Special Programme on Primary Health Care Award, to prevent and control NCDs and provide primary care that is integrated and centered on the needs of the patient, in which India has demonstrated exceptional commitment and effort. More than 34 lakh people with hypertension are receiving treatment in government health facilities, including Ayushman Bharat Health Wellness Centers (HWCs). A straightforward, dose-specific typical therapy regulation, ensuring an adequate supply of custom drugs, decentralizing care with monitoring and prescription refills at HWCs, collaboration on tasks involving all medical staff, and a potent actual time data system that can monitor everyone for monitoring and blood pressure regulation are some strategies. Nearly 50% of patients receiving treatment under IHCI had their blood pressure under control. ¹⁴

A total of 5408 Community Health Center NCD Clinics, 682 District NCD Clinics, and 191 District Cardiac Care Units have been established under NP-NCD. The universal screening of common NCDs has been taught to a total of 7,04,631 Accredited Social Health Activists (ASHAs), 2,19,113 Auxiliary Nurse Midwives (ANM)/Multipurpose Workers (MPW), 28,912 staff nurses, 76,567 Community Health Officers (CHOs), and 29,648 Medical Officers (MOs). ¹⁵

Challenges

1. Limited Awareness in Rural Areas: Rural areas continue to have poor awareness about hypertension despite attempts. Diagnosis and treatment are consequently put off.

2. Adherence to Treatment: Many people with hypertension have difficulty adhwering to their treatment plans, resulting in inadequate blood pressure management.

3. Health Inequalities: Access to and availability of healthcare services continue to be issues, and controlling hypertension can be particularly difficult for some underprivileged communities.

4. Data Collection and Monitoring: Obtaining accurate and current information on the rate of hypertension and its effects remained complex. This made it harder for the government to successfully carry out targeted measures.

Role of Youth in Hypertension Control

The youth are essential to managing hypertension and avoiding its long-term problems. They can support initiatives to reduce hypertension in several ways:

Awareness Campaigns: Young people can take part in efforts to raise public knowledge of the significance of routine monitoring of blood pressure, the benefits of adopting a healthy lifestyle, and the effects of uncontrolled hypertension.

Lifestyle Role Models: By leading healthy lives themselves, such as getting regular exercise, eating a balanced diet, abstaining from tobacco and excessive alcohol use, and managing stress, one might encourage others to follow suit.

Peer Education: Youth can participate in peer-to-peer education in classrooms, educational institutions, and communities to disseminate information about hypertension and encourage others to adopt preventive measures.

Digital Health Initiatives: The youth can develop and spread digital health initiatives aimed at raising awareness of and encouraging self-monitoring for hypertension by utilizing technology and online platforms.

Way Forward

1. Primary healthcare facilities must continue to be improved in order to provide effective hypertension screening, diagnosis, and control.

2. Reaching marginalized communities and rural areas by extending community-based activities and awareness campaigns.

3. Implementing health promotion programs to promote lifestyle changes such as a balanced diet, frequent exercise, and quitting smoking.

4. Telemedicine: Using digital health and telemedicine solutions together to increase accessibility to health care, particularly in remote locations.

5. Data and Research: Improving data collection, surveillance, and research to track patterns of hypertension prevalence and effects and create interventions that are supported by the available scientific evidence.

Conclusion

India still needs to combat hypertension on several fronts because it is a serious public health issue. Through the NP-NCD, IHCI, and other programs like Ayushman Bharat, the Indian government has taken proactive measures to control the menace of hypertension. As powerful agents of change, adolescent participation in these initiatives has the potential to be a game-changer. The youth can greatly help control hypertension in India and build a more sustainable future for the country by spreading knowledge and encouraging healthy habits.

Disclaimer

The views expressed in the submitted article belong to the authors and not an official position of the institution. The manuscript has been read and approved by all the authors. The requirements for authorship have been met, and each author believes that the manuscript represents honest work.