The Hindu : Opinion / Editorials : WATCHING HYPERTENSION

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Friday, Sep 10, 2004

Opinion

Opinion - Editorials

WATCHING HYPERTENSION

THE REVELATION THAT there has been a sharp rise in the prevalence of high blood pressure in the United States over the last decade must prompt a closer review of the public health challenge hypertension poses worldwide. Extrapolating health data across countries would be unsound given the differences in social indicators and biological factors. However, it is widely accepted that the burden imposed by conditions such as hypertension is rising for many developing countries, including those in South Asia. This is reflected in the growing incidence of coronary heart disease, stroke, and renal failure. The data from the National Health and Nutrition Examination Survey in America reported in the journal Hypertension reveal a 30 per cent increase in the prevalence of high blood pressure over the past decade, with the majority of the afflicted being at least 45 years old. The factors thought to be responsible for the increase are longevity, which results in a greater proportion of old people in the population, and obesity, which is viewed as an epidemic in parts of the industrialised world.

The burden of disease, communicable and otherwise, in India and the rest of the sub-continent is reflected in a recent review conducted by the British Medical Journal (BMJ). The prognosis for the countries of the region appears to be that the affluent classes would learn to cope with chronic disease while poor people would die earlier. Almost half of all deaths in South Asia are attributable to non-communicable diseases; a significant proportion can be traced to diseases arising from hypertension. As lifestyles change, there is a clear indication that hypertension is positively associated with higher socio-economic status in both urban and rural contexts. Although researchers find national data on the condition insufficient because of the weak reporting mechanisms in the country, cross-sectional surveys peg the prevalence of high blood pressure in urban areas at 20 to 40 per cent (which is comparable with parts of the developed world) and a not insignificant 12 to 17 per cent in the countryside.

The importance of detecting and managing hypertension must be understood in the context of the high cost it imposes on both the individual and the public health care system by contributing to complications affecting the heart and kidneys. According to one current estimate, the direct cost of medicating patients and managing coronary heart disease events, including bypass operations in the private sector, is at least Rs.100 billion annually. It is also significant, as the BMJ review notes, that appropriate management and prevention strategies can avert 80 per cent of heart attacks. Medical professionals in many countries agree that it is vital that prevention is strengthened, beginning with the introduction of routine testing and monitoring at the level of the primary health centre. The National Health Service in the United Kingdom has set for itself the goal of identifying and adding more people to the list of those on medication to manage hypertension. Such an approach would deliver great human and economic value in the Indian context. The key to the control of hypertension in the stress-ridden urban environment is counselling by the general practitioner on modification of lifestyles. Some medical experts believe that rising affluence has introduced unhealthy diets and habits like smoking, while removing most physical exercise from the daily routine. The alternative view is that the beneficiaries of counselling have adopted healthier lifestyles and are better placed to manage their risks, a luxury not available to the poor who rely on the largely impersonal public health system.

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