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Hypertension: Public health failure

by Admin-Phmp

Text by Henrylito D. Tacio
Photo by Mufid Majnun/Unsplash

Most of the people with high blood pressure are living in low and middle-income countries, according to a report released by the Geneva-based World Health Organization (WHO) last August 25.

The report, based on a study co-led by Imperial College London, found that 82% of all people with high blood pressure live in low and middle-income countries. About one billion people have hypertension or elevated blood pressure.

The study, covering the period 1990-2019, includes data from 184 countries, covering 99% of the global population. It provides data by country and highlights where the most progress has been made.

The researchers found that Canada, Peru, and Switzerland had the lowest prevalence of hypertension in the world in 2019, while some of the highest rates were seen in the Dominican Republic, Jamaica, and Paraguay for women and Hungary, Paraguay, and Poland for men.

In the Philippines, at least 21% of adults are hypertensive, Dr. Dante Morales, president of the Philippine Society of Hypertension (PSH), reported. Based on data from the World Health Organization, hypertension causes 7 million deaths annually while 1.5 billion people suffer due to its complications.

“Most of the time, hypertension has no symptoms,” Dr. Morales explained in a news item disseminated by the Philippine Council for Health Research and Development. “This makes the condition more dangerous. If left untreated, the arteries and other vital organs in the body will be damaged.”

Among the complications of hypertension are heart attack, stroke, heart failure, aneurysm, and renal failure. Of these, heart attack remains as the most common cause of death among Filipinos. “This may be attributed to continuous neglect of the danger of hypertension and its complications,” Dr. Morales said.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.

Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is more or less 140 mmHg and/or the diastolic blood pressure readings on both days is more or less 90 mmHg.

When hypertension happens, there are no symptoms. “When symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears,” the WHO explains. “Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.”

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. “Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions,” the WHO says.

Hypertension is a serious medical condition. It can cause serious damage to the heart. “Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart,” the WHO says.

The elevated pressure and reduced blood flow can cause chest pain (also called angina), heart failure (which occurs when the heart cannot pump enough blood and oxygen to other vital body organs), an irregular heartbeat (which can lead to sudden death).

The most common complication is a heart attack. This occurs when the blood supply to the heart is blocked, and heart muscle cells die from lack of oxygen. “The longer the blood flow is blocked, the greater the damage to the heart,” the WHO says.

Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke. In addition, hypertension can cause kidney damage, leading to kidney failure.

Stroke is the second leading cause of death among Filipinos, accounting fo5 65.66 deaths per 100,000 population. Stroke can either be ischemic (a blockage in the brain’s blood supply) or hemorrhagic (a leak or rupture in a blood vessel in the brain).

Although it is straightforward to diagnose hypertension and relatively easy to treat the condition with low-cost drugs, the recent study revealed significant gaps in diagnosis and treatment. About 580 million people with hypertension were unaware of their condition because they were never diagnosed. The study also indicated that more than half of people with hypertension, or a total of 720 million people, were not receiving the treatment that they needed.

In the Philippines, studies have shown that only 14 percent of Filipinos with hypertension are aware of their condition. Of those who know they’re hypertensive, only half are taking medications; and of those who are taking medications, less than half have their blood pressure controlled to optimal levels.

“Nearly half a century after we started treating hypertension, which is easy to diagnose and treat with low-cost medicines, it is a public health failure that so many of the people with high blood pressure in the world are still not getting the treatment they need,” said Professor Majid Ezzati, senior author of the study and Professor of Global Environmental Health at the School of Public Health at Imperial College London.

The overall number of adults aged 30-79 years with hypertension has doubled from 650 million to 1.28 billion. However, this is primarily down to population growth and aging, and the percentage of people who have hypertension has changed little since 1990.

“All adults should have their blood pressure checked routinely,” the WHO advises. “It is important to know your numbers. If blood pressure is high, they need the advice of a health worker.”

Living a healthy lifestyle plays an important role in treating hypertension. Among the prevention strategies are: reducing salt intake (to less than 5 grams daily) and alcohol consumption; eating more fruits and vegetables; avoiding the use of tobacco; limiting the intake of foods high in saturated fats; eliminating/reducing trans fats in the diet, and being physically active on a regular basis.

For managing hypertension, the United Nations health agency recommends the following: reducing and managing stress, checking blood pressure regularly, treating high blood pressure, and managing other medical conditions.

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