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Kaur P, Sakthivel M, Venkatasamy V, Jogewar P, Gill SS, Kunwar A, Sharma M, Pathni AK, Durgad K, Sahoo SK, Wankhede A, Kumar N, Bharadwaj V, Das B, Chavan T, Khedkar S, Sarode L, Bangar SD, Krishna A, Shivashankar R, Ganeshkumar P, Pragya P, Bhargava B. India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022. Glob Heart 2024; 19:30. [PMID: 38524909 PMCID: PMC10959138 DOI: 10.5334/gh.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 03/26/2024] Open
Abstract
Background Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. Methods We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Results Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Conclusion Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
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Affiliation(s)
- Prabhdeep Kaur
- ICMR - National Institute of Epidemiology Author Institution is Unverified Chennai, IN
| | | | | | - Padmaja Jogewar
- State NCD Cell, Directorate of Health and Family Welfare, Government of Maharashtra, Mumbai, IN
| | - Sandeep S. Gill
- State NCD Cell, Directorate of Health and Family Welfare, Government of Punjab, Chandigarh, IN
| | - Abhishek Kunwar
- Division of Noncommunicable Diseases, WHO Country Office for India, New Delhi, IN
| | - Meenakshi Sharma
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Kiran Durgad
- IHCI project, WHO Country Office for India, New Delhi, IN
| | | | - Amol Wankhede
- IHCI project, WHO Country Office for India, New Delhi, IN
| | - Navneet Kumar
- IHCI project, State NCD Cell, Chandigarh (Punjab), WHO, IN
| | | | - Bidisha Das
- IHCI project, District NCD Cell, Bhatinda (Punjab), WHO, IN
| | | | - Suhas Khedkar
- IHCI project, District NCD Cell, Satara (Maharashtra), WHO, IN
| | - Lalit Sarode
- IHCI project, District NCD Cell, Nashik (Maharashtra), WHO, IN
| | - Sampada D. Bangar
- Division of Epidemiology and biostatistics, ICMR-National AIDS Research Institute, Pune, IN
| | | | - Roopa Shivashankar
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Pragati Pragya
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | - Balram Bhargava
- Department of Health Research, MoHFW, Indian Council of Medical Research (ICMR), New Delhi, IN
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