May 17th is World Hypertension Day. It aims to educate everyone, that the key to prevention or early treatment for heart and vascular problems starts with regular blood pressure screening. It aims to advocate blood pressure screening as a part of routine health checks available to everyone, in order to reduce the burden of vascular diseases on individuals and communities.
Hypertension is a condition in which the blood pressure in the arteries is persistently elevated. Normal blood pressure is less than 120/80 millimeters of mercury (mmHg). The top number 120 is the pressure at its maximum as the heart contracts (systolic pressure), and the bottom number is the minimum as the muscle releases (diastolic pressure). Uncontrolled BP is defined as a condition when the systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg).
According to the International Society of Hypertension, raised blood pressure is the most significant contributing risk factor for preventable deaths worldwide, costing an estimated 10 million lives each year. Yet only 46.5 percent of those people who have the condition know about it.
Over 1.1 billion people globally are affected with hypertension, and this number is expected to increase to over 1.5 billion by 2025.
“Identifying hypertension can achieve very real improvements in health, because it allows us to intervene before treatment becomes costly,” says Dr. Steven Nissen, M.D., Chair of Cardiovascular Medicine at Cleveland Clinic, USA.
He further adds that hypertension is a risk factor in several cardiovascular diseases, as well as stroke, chronic kidney disease and dementia. Yet despite its serious consequence, there are frequently no identifiable symptoms, which makes screening for hypertension essential.
“Knowing this number means we can take action to prevent more serious diseases from developing. In many cases, we can do this through lifestyle changes such as improvements in diet and exercise. Particularly for people with limited access to medical care, a blood pressure test can save a life.”
The Situation in Asia and Singapore:
In Singapore, about a quarter of people with hypertension are unaware and therefore remain untreated. In addition, about a third of those diagnosed on treatment have uncontrolled blood pressure (BP).
While the prevalence of hypertension among Singaporeans as a whole has lowered slightly in the past twenty years, the prevalence among Singaporeans over 40 years old have risen notably. With our ageing population, prevention and control of hypertension is an increasing challenge. According to Global Burden of Disease 2016, high blood pressure confers the highest attributable risk of death in Singapore.
However, the reasons for the poor BP control among individuals with hypertension are not very well understood.
In an attempt to understand why, researchers at the Duke-NUS Medical School, led by Professor Tazeen Jafar, and funded by the UK-Medical Research Council, Wellcome Trust, and Dfid, studied participants treated for hypertension.
The study was done on the rural communities of Bangladesh, Pakistan, and Sri Lanka, as hypertension is a particularly serious problem in South Asia, where the prevalence of hypertension is 40%.
Three main barriers to controlling hypertension:
- Often, the participants do not take their antihypertensive medicines. These findings are consistent with other reports of adults with uncontrolled BP in other low- and middle-income countries.
- The participants were only prescribed one antihypertensive medication. Studies have shown that it takes two to three antihypertensive medications to control BP.
- Finally, a lack of familial or social support. For example, single participants were more likely to have uncontrolled hypertension compared to married participants. Programmes to engage family support have shown promising results in rural China.
Professor Jafar, who is a Professor at the Health Services & Systems Research Programme at Duke-NUS, advised that while failing to control BP can lead to more severe health problems, lowering BP does reduce the risk for cardiovascular and kidney disease. “Controlling BP should be a priority, as the consequences of a lack of action will be far more costly,” she added.
Source: DUKE-NUS, research paper