Often loaded with emotional overtones, many of us are guilty of saying words to the effect, “The traffic snarls while driving to work make my blood pressure rise” or “my blood pressure shoots up every time my boss calls me for a meeting.”
As innocuously as these phrases are uttered, their casual inclusion in common parlance reflects their grim influence on our lives. And that is a matter of great concern.
As per the Global Burden of Disease (GBD) 2015 report, hypertension or high blood pressure caused 16.4 lakh deaths in India in one (every) year. It is the single biggest risk factor for heart attacks and stroke, and often detected only after deadly complications have occurred.
Why it should be checked
So, what really is high blood pressure? Simply put, the pressure of blood in the arteries, which carry blood from the heart to the brain and other parts of the body, is referred to as blood pressure. Having high blood pressure or hypertension means that an individual’s blood pressure is consistently higher than recommended levels. Contrary to popular belief, there are no early warning symptoms and the only way to find out whether you have hypertension is to have it measured. Hypertension can be easily detected and managed in consultation with your doctor. All individuals above the age of 18 should get their blood pressure checked at least once a year. Unfortunately, if left uncontrolled, hypertension can lead to a heart attack, stroke, kidney failure, blindness and cognitive impairment.
A 2016 study indicates that about 30% of adult Indians have hypertension (34% in urban and 28% in rural areas). The rate has almost doubled in the past 20 years, and the gap between rural and urban dwellers is closing. Worryingly, less than 40% of people had any general awareness about hypertension and only 12% of people with high blood pressure had it under control. Another study by the Indian Council of Medical Research’s (ICMR) Medical Research Centre in Dibrugarh, Assam, showed hypertension in 60% migrant tea garden workers in Assam who have an age-old practice of consuming salted tea. High rates of hypertension have also been reported in populations in the Himalayan region who consume salted tea.
Keeping hypertension at bay
Another ICMR study showed that reducing salt intake led to a significant reduction in blood pressure levels, with about half of those affected responding to lower salt consumption. Similarly, a community-based intervention of a low salt diet (including giving up salted tea) and intensive health communication among tea garden workers in Assam, resulted in a significant drop in mean blood pressure levels.
A new initiative is being spearheaded by ICMR and Vital Strategies, and working with the Central and State governments, the World Health Organisation and CDC. Here, an algorithmic-based approach to BP management will be implemented involving front-line health workers such as Accredited Social Health Activists and Auxiliary Nurse Midwives. They will monitor BP control (levels) at facility- and community-levels in 50 pilot districts across six States. Unless BP management is decentralised, standard treatment algorithms accepted, drug availability ensured, regular monitoring done and private sector involved, it is unlikely that control rates can be improved. The health and wellness centres (previously sub-centres) envisaged by the government will focus on preventive and promotive (enabling) health care, where screening and management of diabetes and hypertension will be key activities. Counselling on diet and exercise and other lifestyle changes as well as integration of yoga and Ayurveda can also play a very important role in keeping people healthy. This is one step to help achieve a goal of 25% reduction in hypertension levels in India by 2025.
Dr. Soumya Swaminathan is Director General, Indian Council of Medical Research and Deputy Director General at the World Health Organisation