Pressure points

Indians need better diagnosis and treatment of hypertension

Findings by the World Health Organization (WHO) on the dangerous prevalence of untreated hypertension in India are pointers to the country’s inadequate health care system and the unhealthy lifestyles of  increasingly prosperous Indians. The WHO report found that only 37 per cent of the 188.3 million Indians living with hypertension were aware of their situation, only 30 per cent of those diagnosed started treatment, and just 15 per cent managed to control the disease. The latter fact points to the key problem. In most developed countries where populations are screened, diagnosed, and treated, about half manage to control their blood pressure. The fact that India has a low success rate in terms of efficacy of treatment among those who do get diagnosed is concerning. The WHO findings do not amount to a public health crisis of the same magnitude as, say, tuberculosis, malaria, or dengue.

India does not figure among the top 10 countries with the highest hypertension prevalence — that is between 47 and 51 per cent of the population. Paraguay tops the rankings for both men and women. Nor does it figure among countries with the lowest prevalence, either — between 17 and 26 per cent of the population. Interestingly, China weighs in at number nine in the ranking for women in the latter category. But the WHO’s latest India findings do offer an indicator to the high human development costs, with larger numbers of younger Indians succumbing to heart problems and the growing risks of low awareness. The causes, as physicians testify, are the growing mismatch between the traditional Indian diet heavy in salt, spices, carbohydrates, and sugar, better suited for those who do physical work, and the increasingly sedentary lifestyles with low physical activity. Inadequate exercise and anxiety, the bane of modern lifestyles, add to general threat levels. All of this makes controlling the disease tougher when it is diagnosed. The fact that the symptoms rarely manifest themselves except in extreme events such as heart attacks or strokes has earned hypertension the label of “silent killer”.

The report says that by treating half the people with hypertension, the country can prevent 4.6 million deaths due to heart attacks and strokes. In India, more than half the deaths from cardiovascular disease are on account of high blood pressure. The more unacknowledged and unstated fact is that hypertension and detection are largely a privilege of the rich who can afford the expense of annual health check-ups, where such problems typically show up. This is why it is labelled a rich man’s disease in India — ironic, given that blood pressure medication in India is relatively cheap. The WHO’s statistics suggest that it is widely prevalent down the value chain as well. The encouraging news is that the government has been cognizant of this fact. In 2017, the government launched the Indian Hypertension Control Initiative with the “25 by 25” goal — reducing through primary care the prevalence of high blood pressure by 25 per cent by 2025. It has so far enrolled 5.8 million people with hypertension in 27 states, which is modest progress, given the magnitude of the problem. A concerted awareness exercise of the kind that proved effective in propagating the birth control campaign may be necessary to address the problem before it becomes a bigger nationwide crisis.