IHCI – Indian Hypertension Control Initiative 25 by 25

Uncontrolled blood pressure is one of the main risk factors for cardiovascular diseases (CVDs) such as heart attacks, strokes and kidney failure, which are a leading cause of death and disease. CVDs are accountable for one-third of total deaths in India. Of the estimated 220 million people living with hypertension in India, only 12% have their blood pressure under control.

Indian Hypertension Control Initiative (25 by 25)

India has set a target of 25% relative reduction in the prevalence of hypertension (raised blood pressure) by 2025. (25by25)

IHCI is a collaborative initiative of Ministry of Health and Family Welfare, Indian Council of Medical Research, state governments and World Health Organization Country Office for India.

Launched in 2017

IHCI’s easily scalable strategies include

• A simple drug-dose-specific standard treatment protocol
• Ensuring adequate quantity of protocol medications
• Decentralization of care with follow-up
• Refills of medicines at Ayushman Bharat Health & Wellness Centres (AB-HWCs)
• Task sharing involving all health staff
• Real-time information system to track every patient for follow-up and blood pressure control.

There are 5 crucial components of effective hypertension care that are part of the IHCI programme.

TREATMENT PROTOCOL

High BP: SBP ≥140 or DBP ≥ 90mmHg

Check for compliance at each visit before titration of dose or addition of drugs

After 30 days measure BP again. If still high:
Check if the patient has been taking medications regularly and correctly. If yes, refer to a specialist.

• If SBP ≥ 180 or DBP ≥ 110, refer the patient to a specialist after starting treatment.
• If SBP 160-179 or DBP 100-109, start treatment on the same day.
• If SBP 140-159 or DBP 90-99, check on a different day and if still elevated, start treatment.

Hydrochlorothiazide can be used if Chlorthalidone is not available (25 mg starting dose, 50 mg intensification dose).

Recommended investigations at the initiation of therapy:

• Haemoglobin
• Blood sugar
• Urine analysis for proteinuria
• Serum creatinine.

LIFESTYLE ADVICE

• Eat 5 servings of fruits and vegetables per day.
• Avoid papads, chips, chutneys, dips, pickles etc
• Use healthy oils: E.g. sunflower, mustard, groundnut, etc
• Limit consumption of foods containing high amounts of saturated fats.
• Reduce weight if overweight.
• Reduce fat intake by changing how you cook:

– Remove the fatty part of meat
– Use vegetable oil
– Boil, steam, or bake instead of fry
– Limit reuse of oil for frying

• Avoid processed foods containing trans fats.
• Avoid added sugar.

MANPOWER

IHCI activities are supported by a cadre of Cardiovascular Health Officers (CVHOs) and Senior Treatment Supervisors (STSs). CVHOs are public health professionals recruited under the project at the State and district level who work closely with the Government in the operationalisation of the project. They provide supportive supervision, monitoring and evaluation and advocacy at the State and district level and are recognised to be of great value in supporting the rollout of the Initiative. Senior Treatment Supervisors (STSs), are non-medical graduates deployed under the project at sub-district level to support CVHOs in supervision and monitoring.

WHY IN NEWS?

2022 UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award at a UN General Assembly side-event held on 21 September 2022 in New York. The award recognizes India’s “highly impactful, large-scale hypertension intervention within India’s existing primary health care system”.