Taming the 'silent killer': How Rajasthan is winning the fight against hypertension

Hypertension is often called the “silent killer”. While communicable diseases once dominated the public health agenda, the growing burden of non-communicable diseases (NCDs) has shifted attention toward hypertension, a major risk factor for heart disease, stroke, kidney disease, and premature mortality. Rajasthan's journey toward controlling hypertension offers valuable lessons on both the promise and limitations of India's evolving primary healthcare system.

The scale of the challenge is enormous. Nationally, approximately one in four adults suffers from hypertension, yet only a small proportion (approximately 20%) achieve adequate blood pressure control. These numbers expose the central challenge: hypertension control is not merely about identifying patients; it is about ensuring continuous care. The “last mile” in hypertension management is often where health systems struggle. Patients must be screened, diagnosed, initiated on treatment, supplied with medicines, monitored regularly, and motivated to adhere to lifelong therapy. Failure at any point weakens the entire chain.

Fortunately, Rajasthan has demonstrated that improvement is possible. Rajasthan appears to fare relatively better than many Indian states in terms of hypertension prevalence. Analysis of NFHS-5 data found that Rajasthan is among the top five states with the lowest prevalence of hypertension among men and women.

One of Rajasthan's most significant achievements has been the adoption of standardised hypertension treatment protocols across all the public health facilities. Historically, hypertension management often varied between providers and facilities, resulting in inconsistent treatment practices. By implementing state-specific protocols aligned with national recommendations, Rajasthan simplified treatment decisions and improved clinical consistency.

A second notable strength has been the state's focus on decentralised, primary-care-based management. Through Health and Wellness Centres under Ayushman Bharat and the strengthening of NPNCD services, hypertension care is increasingly being delivered closer to people's homes. This is particularly important in Rajasthan, as it is the largest state in India and geography determines everything about access to care. Covering 3.4 lakh square kilometres, the state has a population density of 200 people per square kilometre, less than half that of India as a whole.

Rajasthan has also demonstrated the importance of investing in its frontline workforce. Following the launch of the India Hypertension Control Initiative (IHCI) in districts such as Churu and Bikaner, extensive capacity-building programmes were conducted for Medical Officers, Community Health Officers, ANMs, Staff Nurses, Pharmacists, and ASHAs. These trainings emphasised accurate blood pressure measurement, patient counselling, treatment protocols, and lifestyle modification messages. District-level monitoring teams played a critical role in mentoring frontline workers and ensuring quality implementation.

Another best practice has been the state's emphasis on team-based care. Hypertension management is no longer viewed as the sole responsibility of physicians. ANMs monitor blood pressure, pharmacists facilitate medicine availability, ASHAs support follow-up and adherence, and Community Health Officers coordinate patient management. This collaborative approach reduces workload on physicians while ensuring continuity of care. Such task-sharing has emerged as one of the core pillars of successful hypertension management in Rajasthan.

Ensuring the uninterrupted availability of medicines has been another area of progress. Rajasthan has increasingly aligned its hypertension programme with standardised drug procurement and supply systems. National evidence clearly demonstrates that reliable availability of first-line antihypertensive drugs significantly improves treatment continuity and patient outcomes. By reducing medicine stock-outs and making drugs available at peripheral facilities, Rajasthan has lowered barriers to long-term treatment adherence.

Perhaps one of the most promising developments has been Rajasthan's growing use of digital monitoring systems. The state has adopted patient-tracking mechanisms through the National NCD Portal and related information systems that allow facilities to register patients, monitor follow-up visits, and track blood pressure control rates. The recently completed Rajasthan Initiative for Systemic Hypertension and Diabetes Intervention (RAHAT) project further demonstrated how regular programme reviews, data-driven decision-making, and continuous supportive supervision can improve treatment coverage and blood pressure control.

The state has also shown the value of supportive supervision. Rather than relying solely on periodic reporting, Rajasthan has increasingly emphasised field mentoring, monitoring visits, and performance reviews. Experiences have highlighted how block-level training and district monitoring mechanisms improved the quality of hypertension services and strengthened adherence to standard protocols.

There are still challenges ahead. Awareness remains suboptimal, treatment adherence needs improvement, and lifestyle risk factors such as unhealthy diets, tobacco use, obesity, and physical inactivity continue to rise. Yet Rajasthan's journey offers optimism and provides a practical roadmap for improving hypertension outcomes at scale. As India seeks to reduce premature mortality from cardiovascular diseases and achieve universal health coverage, Rajasthan's experience demonstrates that the last mile of hypertension control can be reached, not through a single breakthrough intervention, but through the consistent implementation of proven public health practices.

The author is an additional professor, community medicine & family medicine and coordinator, School of Public Health, All India Institute of Medical Sciences, Jodhpur. 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.