Expanding the reach of lifesaving hypertension care

A silent killer, hypertension – also known as high blood pressure – is all too common. One in every five adults around the world lives with high blood pressure.???

But a recent study from India shows that programs can dramatically improve control of this dangerous condition by decentralizing care and making it easier for people to get treatment.?

The India Hypertension Control Initiative (IHCI), a partnership with the Ministry of Health and Family Welfare, the World Health Organization India, the Indian Council of Research and Resolve to Save Lives, introduced a pilot program in 2017 inspired by successes treating HIV and tuberculosis: decentralized care.??

Ayushman Arogya Mandir (AAM), formerly known as Health and Wellness Centres, are community-based healthcare facilities in India designed to provide comprehensive primary care services, including preventive and curative health care. These facilities are part of the Ayushman Bharat initiative, providing care to people who might not otherwise be able to access it. The AAM program in India is the most encouraging development I’ve seen in the nearly 30 years I’ve had the honor and privilege of working alongside colleagues in India. Taking advantage of a growing and evolving network of AAMs across India, IHCI trained nurses and other community health workers on how to effectively measure blood pressure, counsel patients, prescribe treatment and manage care.??

The results of the shift in hypertension care to AAMs have been striking. With decentralization, over the course of just three years, from 2019 to 2022 and despite the Covid pandemic, overall control of high blood pressure rose from 20% to 58% in the nine districts of Punjab and Maharashtra where the pilot program took place. Missed patient visits – a key challenge in hypertension management – decreased from 61% to 26%. These trends were consistent across the two states.?

As countries pursue approaches to improve blood pressure control, expanding the reach of care through decentralization, as India is doing with the Ayushman Arogya Mandir platform, offers a promising strategy.

Around the world, it’s hard to provide treatment to the people who need it the most – especially in areas where access to health care is limited. Large hospitals and other facilities are often out of reach and have to deal with a range of complex health issues. High patient load is another challenge. This means that for health care providers, it can be difficult to start and keep track of their patients’ treatment protocol. And for people living with high blood pressure, it can be difficult to remember to take a pill every day for the rest of their lives and time-consuming to access care is hospitals or large health centers. Decentralization of care to local community health posts is a powerful driver of progress.?

India is leading the way in showing how programs can improve access to treatment for high blood pressure and save lives – lessons the world can learn from.