Hypertension-mediated Organ Damage Care in India Go-Real (Guidelines tO Real World) Application: Expert Opinion

Hypertension is a global health concern. India alone is home to an estimated 220 million adults with hypertension. Only one in three Indians received a diagnosis for hypertension, less than one in five were treated, and only one in 12 achieved blood pressure control. Such patterns of undiagnosed, untreated, and uncontrolled hypertension all contribute to an increased risk of hypertension-mediated organ damage (HMOD). The presence of HMOD is related to increased vascular risk and mortality, further worsening the brunt of hypertension. HMOD can predominantly affect the heart, kidney, brain, and eye. An early and timely assessment of HMOD can help in appropriate cardiovascular risk stratification and applying effective treatment strategies. The international and national guidelines' recommendations for assessment of HMOD in hypertension are very comprehensive. While they are appropriate to be applied universally, there are challenges to following them for HMOD assessment in real-world practice settings in India. The aim of this expert opinion and review is to simplify the HMOD assessment modalities such that they are actionable and consistently applicable across diverse cardiology practice settings in a cost-effective way in India. The paper encompasses certain novel tools that may help in HMOD assessment in a larger hypertensive population, developed under the guidance of Indian cardiologists, nephrologists, neurologists, and ophthalmologists. The HMOD assessment for each organ-namely heart, kidney, brain, and eye-has been categorized into "essential" and "optimal" for practical purposes. The ultimate vision of this document is to simplify HMOD assessment and ensure that clinicians are able to conduct "essential" assessment in most eligible hypertensive patients and timely refer them to a specialist when more comprehensive assessment is needed, with an ultimate endeavor to reduce the burden of HMOD and its sequelae in the country.