Scaling India Hypertension Control Initiative strategies to 15 states-treatment outcomes and risk factors for uncontrolled blood pressure, India: a cohort study, 2018-2021

Abstract

Objectives: To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).

Design: An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.

Setting: All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.

Participants: Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.

Outcome measures: Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022-31 March 2022). We analysed the risk factors for uncontrolled BP.

Results: Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (<45 years) (adjusted risk ratio, aRR2=1.05, 95% CI 1.03 to 1.06), males (aRR2=1.08, 95% CI 1.07 to 1.09), diabetics (aRR2=1.11, 95% CI 1.11 to 1.12) and those in higher-level facilities had a greater risk of uncontrolled BP.

Conclusions: We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.

Keywords: Cardiovascular Disease; Epidemiology; Health policy; Hypertension.

Figure 1. Treatment outcome among individuals with hypertension undercare by state under India Hypertension Control Initiativein the reporting quarter in 15 states of India, January–March 2022 (N=1,046,512).

Figure 2. Blood pressure control based on two readings among individuals with hypertension undercare by the state in India Hypertension Control Initiative (IHCI) in the reporting quarter in 15 states of India, January–March 2022 (N=667,710).