It is estimated that 33 percent of adults aged 30-79 worldwide — roughly one in every three adults — have hypertension.
Published May 17, 2024 | 7:00 AM ⚊ Updated May 17, 2024 | 1:36 PM
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At 36 years old, Ramesh Reddy — a maintenance technician at a 24×7 industrial facility in the Ballari district of Karnataka — found his rotating shifts disrupting his sleep and limiting his ability to maintain a healthy lifestyle.
He frequently experienced headaches (particularly in the early mornings), episodes of dizziness, and occasional heart palpitations.
Although he initially dismissed these symptoms as work-related stress, he was taken aback when primary healthcare workers advised him to undergo screenings for various illnesses.
These tests revealed that his symptoms were caused by hypertension.
Ramesh is among the staggering 1,75,048 individuals diagnosed with hypertension in Ballari, which has the highest number of hypertension cases in the district.
However, Ballari is not alone; across the 31 districts of Karnataka, the “Gruha Arogya” door-to-door screening programme conducted by the Karnataka government has identified 20,52,151 people with hypertension.
Then there is the story of Shantipriya, a 39-year-old mother of two who was also diagnosed with hypertension and was asked to start on medications despite being a homemaker.
She spoke to South First from Mysuru, the district that has the second-highest number of hypertension cases reported in Karnataka.
Shantipriya said, “My typical day begins before sunrise, tending to my small vegetable garden and looking after my two schoolgoing children. Despite this active routine, I began experiencing symptoms of hypertension–mainly headaches and fatigue.”
She recounted: “I visited the local clinic where they found my blood pressure to be on the higher side. I had not anticipated this, but folks at home said it was due to some personal tensions.”
But Shantipriya argued that she was not stressed in any way. However, she had recently started to put on weight and feel lethargic.
Two more screenings from the health department officials under the Gruha Arogya confirmed the condition. and she is now on serious follow-ups by ASHA workers.
Shankar Sonna, a 60-year-old farmer, spoke to South First from Vijayapura, which is the third-highest district with 1,17,766 cases of hypertension.
He said his once-stable life had been disrupted by hypertension. He attributed it to the stress of fluctuating crop prices, adding that erratic weather patterns had taken a toll on his health.
His wife Radha thought otherwise. She said: “Problems with crops and agriculture are not new to them. However, these days my husband eats a lot of bakery items.”
She explained: “My grandchildren love potato chips and other such products, and my husband tends to eat them as well. I feel all this has caused him to turn into a hypertension patient. He has also started to drink alcohol.”
Dr Srinivas Gulur, the joint director of non-communicable diseases at Karnataka’s Department of Health and Family Welfare, heads the Gruha Arogya project. And he concurred with Radha.
Gulur said: “Seepage of junk products, a sedentary lifestyle, the stress and tension of jobs, agriculture patterns, the opening of bakeries in every nook and corner of villages, and no exercise regime have all been found to be some of the reasons hypertension has seeped into villages of Karnataka.”
He added: “Of course, the numbers are high since. We are meticulously screening for such cases.”
The Karnataka government launched the Gruha Arogya initiative — to screen individuals at their doorstep to ensure early detection of lung and breast cancers, hypertension, diabetes, and other non-communicable diseases (NCDs).
Funded by the National Health Mission, the initiative sees people go door to door and screen patients above 30 years of age.
It is being conducted by appointed task forces, comprising community health officers, ASHA workers, and primary healthcare personnel. They screen, rescreen, and then diagnose the patients.
Once diagnosed, the patients are not only referred to the local PHCs for further follow-ups but also offered free medication for all NCDs.
Health staff visit 20 houses over three days a week — Monday, Wednesday, and Friday. Each house is marked with a colour-coded health sticker.
The health status of the individuals is then recorded by the community health officer using the NCD app.
A report by the World Health Organisation (WHO), titled Global Report on Hypertension: The race against a silent killer, was released on 19 September, 2023.
It estimated that 33 percent of adults aged 30-79 worldwide — roughly one in every three adults — had hypertension.
It also estimated that 188.3 million (18.83 core) adults aged 30-79 years in India had hypertension.
WHO classifies hypertension as having systolic blood pressure greater than or equal to 140 millimetres of mercury (mmHg) or diastolic blood pressure greater than or equal to 90 mmHg.
If the blood pressure is high, it can lead to serious health conditions like heart disease, heart attack, stroke, eye damage, and kidney damage.
Common symptoms of hypertension include frequent and persistent headaches, occurring especially early in the morning.
They also include episodes of dizziness or lightheadedness, chest pain, shortness of breath during routine activities and noticeable with mild exertion, blurred vision (as high BP can affect the blood vessels in the eyes, leading to vision problems), heart palpitations (a feeling of rapid or irregular heartbeat), a red or flushed face, and fatigue or unexplained tiredness.
Episodes of confusion have also been linked to high blood pressure.
Some of the factors contributing to hypertension — according to Dr Ravindra, a nephrologist from Ballari, which reports the highest number of cases in Karnataka — include a diet high in salt and fat, a sedentary lifestyle, obesity, stress, genetics, and a lack of access to healthcare.
Economic stress and changing dietary habits in rural areas exacerbate the issue, claimed the doctors.
Hypertension — like diabetes — was considered an “urban” disease and was not as common in rural homes.
However, more recent statistics show that there are more than 20.5 lakh cases in Karnataka alone, having been recorded by door-to-door screening.
Local health clinics and district hospitals report a sharp rise in cases, with adults as young as 30 being diagnosed, said the doctors.
This marked a significant shift in the demographic profile of this disease, which was traditionally believed to affect older and urban populations, they added.
Dr Dayanand, a consultant of nephrology, at Kauvery Hospitals, leading his hospital’s hypertension awareness campaign, told South First, “About 33 percent of urban Indians have hypertension. However, recent studies have shown around 25 percent of people living in rural areas have hypertension.”
He explained that multiple factors were hiking the prevalence of hypertension in villages.
Dayanand said that there had been a shift in the lifestyle of the rural population due to changes in traditional farming practices and the availability of various new machinery.
This, he explained, had led to decreased physical activity. This contributed to a sedentary lifestyle he noted.
Meanwhile, Ravindra said the reason Ballari might be seeing the highest number of hypertension cases in Karnataka — other than the screening — was that several youngsters worked in industrial setup.
“My patients have mostly been the ones working in industries. With erratic shifts and tremendous work pressure, their eating habits and sleep cycles are all messed up,” he explained.
“Along with this, Ballari is a region where they eat a lot of spicy items and too much use of salt. These things may be leading to the increase in hypertension cases,” he added.
Meanwhile, Gulur noted: “Older generation, due to various reasons, are giving up on farming and their children are well settled in urban cities. Several of them have given up on farming and their lifestyle has become sedentary.”
He continued: “Many of them have turned alcoholic as well. Many of these factors contribute to becoming a patient of hypertension.”
Several food scientists and nutrition experts have been expressing concern over the growth of ultra-processed foods and the dangers they pose to human beings.
These products have now seeped into villages as well, they noted, affecting people from children to youngsters to adults.
“There has been a rise in the availability of packaged or processed food and soft drinks due to the influence of Western diets,” explained Dayanand.
“The traditional diet was rich in vegetables, fruites, calcium, and protein, but has now been replaced by processed food. These foods are rich in salt, carbohydrates, transaturated fats and lacking essential nutrients,” he noted.
Gulur added that the dietary transitions were the primary culprit. He said, “The shift from traditional diets to processed foods high in salt and unhealthy fats is dramatic.”
He claimed that bakeries had been the biggest culprit in rural settings. “There used to be hardly any bakery in villages. The maximum one would get was a loaf of bread and probably some cream buns and honey cakes,” he recalled.
“Now, ultra-processed foods are available in villages in various forms. Soft drinks, which were once not available at all, can now be found in these bakeries,” explained the doctor.
“These foods — rich in salt and carbohydrates — are leading to obesity and hypertension in villages,” he said.
Doctors also claimed that the impact of urban influences in Karnataka was palpable in villages close to cities like Bengaluru, Hubballi, and Mysuru, where fast food outlets had become increasingly popular.
Another reason was the socio-economic conditions in the villages. Factors like poverty, limited education, unemployment, and a lack of adequate transportation and healthcare facilities led to delayed diagnosis and an increased burden of untreated hypertension.
The use of alcohol and excessive use of tobacco and over-the-counter medicines or alternate medicines could also increase the risk of hypertension.
Increasing age was also a risk factor for hypertension: With many youngsters moving to urban areas, the elderly were left behind in the villages, which might also be the reason for the increase in cases of hypertension, said Dayanand.
Latha, an ASHA in the Kolar district, faces daily challenges as she navigates through scattered homesteads to educate her community about hypertension.
She said, “Many here don’t realise that salt isn’t just in table salt; it’s in many packaged foods they buy.”
Ravindra said nearly 30 percent of his patients came to him only after severe complications like stroke or kidney problems, and only then would realise that they were patients of hypertension and their BP was uncontrollably high.
“Few of them, despite being told that they have high blood pressure (BP) and must keep it in control, do not take medications,” he claimed.
“Some trust the local registered medical practitioners (RMPs) who measure the BP and tell them that it is normal instead of telling them that it is under control due to the medications that they have been taking, and hence must continue to take medications,” explained the doctor.
The word “normal” makes these villagers believe that their high-BP issue is solved and thus stop medications, leading to stroke or problems related to the heart or the kidney.
Dayanand said people living in villages were not very aware of hypertension, its symptoms and signs, its risk factors, and the ill-effects of uncontrolled BP.
He added that they did not know the importance of preventive health checkups and screening measures either.
Since hypertension was actually termed a “silent killer” with no specific symptoms, most people were not aware that they were hypertensive.
Dayanad also said, “One in every three Indians has hypertension, and 50 percent are not aware that they have high BP. Hence, it is important to check BP and know your numbers.”
The WHO, in its recent report on Indian states that have excellent protocols for hypertension, mentioned Telangana, Karnataka and Kerala for their efforts to screen and treat such cases.
Beyond what has already been mentioned about the Gruha Arogya programme, ASHAs also organise monthly community meetings where they demonstrate healthier cooking options and discuss the importance of physical activity.
Their personal touch and consistent presence are believed to have made a significant difference, at least in Karnataka.
This grassroots approach was vital, said Lakshmi — an ASHA from Davanagere.
She said, “We need to integrate more preventive care and education at the community level. It’s about changing lifestyles and diet as well as understanding the importance of regular check-ups.”
Every ASHA is paid ₹50 every six months to ensure the follow-up of one patient.
“Each ASHA has at least 50-60 patients under her for follow-up, which means it is their responsibility to ensure that patients are taking medications and also taking their health seriously,” said Gulur.
ASHAs are also advised that if the BP is still high, they need to refer the patients to a specialist.
Gulur noted that in Karnataka, they were catching the patients from a young age and follow-up rates were good as well. He urged people to come forward and get their BP checked.
Meanwhile, doctors suggested that it would be best to prioritise blood pressure checks once people turn 20 years of age, irrespective of whether the symptoms presented.
Deepa, a primary school teacher from Chikkamagaluru, observes the impact of dietary changes in the younger generation, which she believes is setting the stage for early-onset hypertension. “Kids as young as 10 prefer chips and soda over nutritious meals,” she noted.
Deepa has started integrating basic health and nutrition education into her curriculum, hoping to instil better habits early in life.
She insisted that textbooks must have lessons on these for children as young as seven or eight years old.
She said, “Educating them about the risks of hypertension and poor diet is just as important as their academic subjects.”
While Karnataka is meticulously screening residents in both urban and rural areas, the protocol developed for hypertension patients in the state is that if the BP is high, patients are first prescribed Amlodipine 5mg.
The BP is measured again after 30 days, and if it is still high, the dosage is increased to 10 mg.
It is measured after another 30 days, and if the BP is still found to be high, another medicine — Telmisartan 40mg — is added.
However, if the patient is a pregnant woman, Telmisartan or Chlorthalidone Statins should not be proscribed.
The authorities have also advised people to eat five servings of fruits and vegetables per day.
Besides these, the experts have also called for the following steps:
(Edited by Arkadev Ghoshal)
