Background: The ever increasing cost of care for Non Communicable Diseases has led to a profound economic impact on healthcare systems especially in Low and Middle Income (LMIC) countries like India. The documentation of total risk approach as a cost effective tool and as a treatment optimization strategy is less. Objective: To establish the optimization of treatment using WHO/ISH risk prediction charts among the newly diagnosed hypertensives during the ‘Great Indian BP Survey’, Puducherry. Methods: ‘The Great Indian BP Survey’ was conducted during September, 2015 on a single day among the adults (≥18 years) including employees, students, patients and public who visited the campus area of a tertiary care institute in Puducherry, India. A standard protocol was used to measure the blood pressure (BP) by 33 different teams. Cardiovascular disease risk assessment was done for those newly diagnosed hypertensive individuals using WHO/ISH chart without cholesterol version for South East Asian region D (SEAR-D). Results: Of the total 9906 adults screened, mean (SD) age was 35.5 (13.5) years and 5080 (51.3%) were males. Of them, 2714 (27.4%) were found to have raised BP and out of these 1539 (56.7%) became aware about their raised BP status for the first time. Of the newly diagnosed, only 6% (93/1539) had WHO/ISH risk score of ≥20%. Conclusion: The study shows that optimization of treatment using WHO/ISH risk prediction can be a cost-effective approach in LMIC like India.