Today, April 7, is World Health Day and the theme this year is hypertension

“There’s an immense body of evidence that links salt to high blood pressure.” — Jeffrey Cutler

Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, but the rates of awareness, treatment and control are low. It is possibly caused by urbanisation, an ageing population, changes in dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control.

Almost three-quarters of people with hypertension (639 million people) live in developing countries with limited health resources. In India, hypertension has increased by 30 times in urban populations over 25 years, and by 10 times in rural populations over 36 years. Many people have no signs or symptoms, even if the blood pressure readings reach dangerously high levels.

There’s no identifiable cause of high blood pressure in most people. Called essential hypertension or primary hypertension, it develops gradually over many years. Some people have high blood pressure caused by an underlying condition. This is secondary hypertension, appears suddenly and causes higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including kidney problems, adrenal gland tumors, certain defects in blood vessels (congenital) and illegal drugs such as cocaine and amphetamines.

Uncontrolled high blood pressure can lead to heart attack or stroke; aneurysm and heart failure; weakened and narrowed blood vessels in kidneys; thickened, narrowed or torn blood vessels in the eyes; metabolic syndrome; and trouble with memory or understanding.

Hypertension control

The primary health-care systems, mainly in developing countries, are often without the most basic equipment, such as a calibrated and functioning sphygmomanometer or a glucometer. Another reason for poor awareness is that hypertension, as an asymptomatic disease, contrasts with the most common clinical situations faced daily by the primary health-care workers. Measurement of blood pressure is seen as a secondary task and is not systematically done. As a result, hypertension is not often diagnosed. A deficient procurement and distribution process of essential drugs for treatment of hypertension is also common.

The three most important steps to increase hypertension control are the use of primary health care centre as the key point of control, deployment of nurses as the main human resource for diagnosis and follow-up and the adoption of a global cardiovascular risk approach as a strategy for treatment.

Governments should make a special effort to supply basic drugs for treatment of hypertension at the primary health level at a fair price. Together with medical societies and non-government organisations, they should promote preventive programmes aimed at increasing public awareness, educating physicians, and reducing the intake of salt. Regulations of the food industry and the production and availability of generic drugs should be reinforced. A reliable, durable, and largely affordable sphygmomanometer that can be widely used at the primary health-care level is urgently needed.

Conclusion

Developing countries need a simple algorithm for screening, treatment, and follow-up to manage hypertension; a reliable drug supply system; free or subsidised drugs; health education about blood pressure and cardiovascular diseases; community programmes aimed at increasing self-referral for risk assessment; improved health record systems (electronic records); a cost-effective drug distribution system; health information systems (e.g., mortality surveillance); and targets for and monitoring of the effect of intervention programmes.

(The writer’s email: dr_rnk@hotmail.com)