The Silent Killer: tackling hypertension in India

WHO report reveals hypertension affects 1 in 3 adults worldwide, with nearly half unaware of their condition. Treatment gaps lead to 76 million deaths by 2050. Indian research shows rising prevalence, especially among young adults and those from lower socioeconomic backgrounds. WHO report highlights lifestyle changes, affordable medications, and improved access to healthcare as key to managing hypertension. India's National Programme for Noncommunicable Diseases aims to provide care for 70 million people with high blood pressure. Cost-effective interventions can avert millions of deaths.

High blood pressure, also known as hypertension, is often called the “silent killer” because it often goes unnoticed until it triggers severe health complications such as strokes, heart attacks, kidney damage, and heart failure. According to medical standards, the reading on a doctor’s BP monitor going above 140/90 accounts for hypertension. The World Health Organization (WHO) released its first-ever report on the global impact of hypertension this Tuesday, highlighting the devastating consequences of this widespread, yet often neglected condition.

The WHO report reveals that hypertension affects one in three adults worldwide, making it a significant global health concern. It is a condition that knows no boundaries, affecting people across age groups and geographical regions. The number of people living with hypertension has doubled from 650 million in 1990 to a staggering 1.3 billion in 2019, with nearly half of these individuals unaware of their condition.

According to the WHO report, nearly four out of five people with hypertension are inadequately treated. However, scaling up coverage could avert 76 million deaths between 2023 and 2050. The report reveals a doubling of hypertension cases from 1990 to 2019, with over three-quarters of affected adults residing in low- and middle-income countries.

“Diagnosing and treating hypertension is the simplest and most basic care even a nurse could give in the absence of a doctor at a primary health care facility, and there is no excuse for any country failing to scale this up,“ said Bente Mikkelsen, Director of Noncommunicable Diseases, WHO, in an online press conference on Tuesday during the release of the report.

Recent research on hypertension in India paints a similar picture. A recent systematic review published in The Lancet Regional Health, Southeast Asia and a community study published in Cureus highlights the growing prevalence of hypertension in the country, particularly among younger adults and those from lower socioeconomic backgrounds. The research papers emphasise that a significant portion of hypertensive individuals in India remain undiagnosed. The lack of awareness about the condition and limited access to healthcare services are critical factors in this trend.

The systematic review examined how well hypertension, or high blood pressure, is managed in India from 2001 to 2020. They found that only about 22.5% of people with high blood pressure had it under control in the most recent period from 2016 to 2020. The Cureus study showed that the number of people with high blood pressure in India increased from 20.4% to 22.8%, especially among those aged 15-49. While more cases are being found through screening, many people (around 58%) with high blood pressure do not know they have it, especially men, those with less education and money, tribal communities, and people living in rural areas. Even when people know they have high blood pressure, six out of ten do not start treatment, so there is a need for interventions to change their health-seeking behaviour.

“The WHO report accurately reflects on hypertension as a public health problem, a significant issue in India,“ said Saurav Basu, Assistant Professor, Public Health Foundation of India, and author of the Cureus study. Through their extensive community surveys, such as the National Family Health Survey (NFHS) and Noncommunicable Diseases (NCD) surveys, researchers such as Dr. Basu have also found what WHO has reported. “We know that many people in India with high blood pressure don’t know they have it, and even when they do, they often don’t receive proper treatment, leading to poorly managed high blood pressure,“ he added.