ICMR - National Institute of Epidemiology Author Institution is Unverified Chennai, IN.
Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, IN.
Glob Heart. 2024 Mar 19;19(1):30. doi: 10.5334/gh.1305. eCollection 2024.
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.
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.
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.
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.
印度的高血压治疗覆盖率较低。逐步的简单治疗方案是提高初级保健中高血压治疗的策略之一。我们评估了在印度高血压控制倡议（IHCI）实施的旁遮普邦和马哈拉施特拉邦的公立部门卫生机构中，各种方案步骤实现血压（BP）控制的效果。
我们分析了 2018 年 1 月至 2021 年 12 月期间在两个邦的 23 个区的公立部门初级和二级保健设施中接受 IHCI 治疗和随访的高血压患者的记录。每个邦都遵循不同的治疗方案。我们计算了方案每一步骤中血压控制的比例。我们还估计了治疗前后 BP 的平均下降。
在开始服用氨氯地平 5 毫克的 281209 名患者中，有 159292 名继续使用方案药物并在 2022 年第一季度前来随访。在旁遮普邦的 33450 名和马哈拉施特拉邦的 125842 名前来随访的人中，分别有 70%和 76%的人在第一步使用氨氯地平 5 毫克时血压得到控制。在旁遮普邦，在第二步使用氨氯地平 10 毫克时，累积血压控制率增加到 75%。在马哈拉施特拉邦，在第二步加入替米沙坦 40 毫克后，这一比例增加了约 5%（76%-81%）。总体而言，旁遮普邦的平均（SD）收缩压（SBP）从基线时的 148（15）mmHg 下降了 16mmHg。在马哈拉施特拉邦，从基线时的 144（18）mmHg 下降了约 15mmHg。
简单的药物和剂量特异性方案有助于在方案条件下保留在护理中的患者中实现高控制率。我们建议根据成本和可用性，从单一低成本药物开始的治疗方案，并根据需要升级为相同或另一种降压药物。
