What are the key findings of this study?
Two surveys done 20 years apart on populations from urban Delhi and adjoining rural areas of NCR suggest a sharp increase in percentage of men and women living with hypertension.
Among citizens above 35 years of age, nearly half of all urban Delhiites and a quarter of those living in rural NCR areas have hypertension.
The worrisome finding was that while the rise in prevalence of hypertension happened across all segments, it was more among the younger population and rural areas, with women being as susceptible to it as men.
Also, management of hypertension is no better than 20 years ago, with less than two out of five people aware that their blood pressure was high, one in three taking any medication and just a little over one in 10 treated adequately.
What are the major factors that have contributed to this state of Delhi’s health?
There are several contributory factors: rise in prevalence of obesity, especially central obesity or belly fat; lack of physical activity; dietary changes with high salt content and low consumption of fruits and vegetables; higher psychosocial stress in day-to-day life and rise in alcohol consumption.
What does this state of health translate into for Delhiites?
Rise in high blood pressure today means more cardiovascular diseases (CVDs) tomorrow. High blood pressure makes one prone to a host of serious diseases including heart attacks, paralytic attack and renal failure.
Around 45% of heart attacks and 51% of paralytic attacks are due to high blood pressure. Failure to manage high BP can have a cascading effect down the years, and is a major cause for the epidemic of lifestyle diseases that we are witnessing.
What does this trend mean for our children?
Children were not part of our study but I would say that a healthy lifestyle has to be inculcated at an early age and we need to create awareness about childhood obesity, which is certainly gaining worrisome proportions in urban India. It makes one susceptible to hypertension, diabetes and cardiovascular diseases at an early age.
In the study, what are the most glaring healthcare concerns in terms of men/women and urban/rural areas?
Globally, high blood pressure is the number one killer; in India it is ranked second. If we do not invest in managing it better along with other risk factors like diabetes, tobacco usage and obesity, we will be facing a huge burden of cardiovascular diseases, especially among the youth.
This means a huge loss of the demographic dividend that we possess as a nation. Economic estimates show that India lost $237 billion to CVD diseases between 2006 and 2015.
The spread of these risk factors among hitherto uncharted territories such as women and rural areas is troubling.
Already, data from many parts of rural India suggest that CVDs are the leading cause of death and disability. This is primarily due to rise in CVD risk factors such as tobacco use, high blood pressure, diabetes and probably the change in food and lifestyle habits.
Among women, we noticed very high rates of obesity and high blood pressure, which was equivalent to men. We also saw a sharp rise in rates of diabetes among women over the last two decades.
Once these risk factors set in, women lose their hormonal advantage for protection against CVDs and become as susceptible as men.
How can a preventive approach change the trend in the next 20 years?
We know that control of high blood pressure decreases the chances of a future heart attack, paralytic attack, renal diseases and heart failure. We need to create awareness among people about this silent disease and ensure that all adults are screened for it at least once a year. The responsibility lies with all medical practitioners to measure the blood pressure of all patients.
Similarly, other risk factors need to be addressed urgently such as tobacco control, diabetes management, encouraging physical activity and improving diet. The health benefits of these interventions are cumulative if not multiplicative.
Experience from western nations suggests that 70% of the marked decline in CVDs mortality that they achieved in the last century was attributed to risk factor control in the population and the rest to management of medical treatments.
