MULTIDISCIPLINARY CONSENSUS ON THE MANAGEMENT OF UNCONTROLLED HYPERTENSION IN INDIA

Abstract

Objective: Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in Uncontrolled Hypertension (UHT). The prevalence of UHT is high in India, with only about 9–20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT Design and method: A Multidisciplinary Panel, comprising of specialists in Cardiology, Nephrology and Internal Medicine, was convened to address the diagnosis and management of UHT in the Indian population. The Panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting Results: • UHT can be defined as the inability to achieve BP control with the use of three medications in optimal doses, with three BP readings taken in three weeks. The condition can be further classified as causative and therapeutic UHT. • The high prevalence of UHT was attributed to the high salt content in the Indian diet (particularly from preserved foods), a lack of awareness and poor adherence to medication. • Diagnosis of UHT involves screening for the following: sleep apnea, cardiac and renal abnormalities, and hyperaldosteronism. Investigations recommended were micro-albumin, blood sugar, kidney function tests, urinalysis, echocardiogram, 24-hour ambulatory BP reading, waist-to-hip ratio, serum potassium and lipid profile. • A detailed algorithm was proposed for management of UHT based on its causes, specific to the presence of cardiac/renal disease, and co-morbidities like Diabetes Mellitus. Recommendations from the panel can rationalize the clinicians’ approach in the management of UHT in India. • A prevention strategy for UHT requires the participation and joint responsibility of clinicians, patients and policymakers. Conclusions: Appropriate treatment recommendations by clinicians, with simplified medication regimens can help improve patient adherence. Identification and reversal of lifestyle factors by patients through education and counselling, and better health literacy through public health campaigns can aid the control of HT in India.