In order to achieve a healthy heart we must combat hypertention, both individually and collectively
The World Health Organization (WHO) in 1999 issued a list of 10 mega causes of death world wide. According to it, heart attacks and strokes put together claimed more than 25 per cent of the total world mortality and occupied the top two positions on the list respectively.
In terms of actual numbers 7.3 million deaths occurred from heart attacks every year, of which 5.4 million deaths occurred in low/middle income countries, which includes Pakistan. One in three people die within a year after surviving their first heart attack. At the same time there are 5.1 million strokes yearly, out of which 4.2 million occur in low/middle income countries. WHO also reported that 10-25 per cent of world adults are obese.
However, what many fail to realize is that hypertension is the most important and frequent predisposing factor for both coronary artery and cerebro vascular diseases. Hypertension has become the most common condition among non-communicable diseases. There are an estimated 600 million hypertensive people world wide. Fifty million Americans suffer from elevated blood pressure (systolic blood pressure > 40mm Hg or diastolic blood pressure > 90mm Hg). Out of these, 70 per cent are aware of their diagnosis but only 50 per cent are receiving treatment and only 25 per cent are under control using a threshold criterion of 140/90.
At the same time, the National Health Survey of Pakistan, jointly conducted by Pakistan Medical and Research Council in collaboration with the Federal Bureau of Statistics Pakistan and the Department of Health and Human Resources University of Washington, USA, conducted between 1990-94 across the country, reported that 18 per cent of the population over the age of 15 has elevated BP levels. Thus there are an estimated 12-13 million hypertensive in Pakistan. The same survey has reported the control rate to be just three per cent. Circulatory diseases are reported to cause over 100,000 deaths per annum in Pakistan.
The World Heart Federation (WHF) has declared South Asia as a high risk region for Ischemic Heart Disease (IHD) which has attained an almost epidemic status in our region. It must be realized that at present, developing countries contribute a greater share to the global burden of cardiovascular diseases than developed countries while at the same time they still face the problems of noncommunicable diseases and nutritional disorders. Thus we are under the dual burden of communicable and non-communicable disease. The situation is further compounded by the fact that we have meagre resources to meet the situation. The projections for the future are a tremendous rise in its numbers. Unfortunately due to socio-economic factors this trend has not been countered with appropriate efforts, both at the individual but particularly at the community level to contain this epidemic.
The crucial factor in hypertension is the fact that the disease happens to be a symptomatic in a vast majority of patients and goes undiagnosed unless it is checked. No wonder it is called the silent killer. Therefore the fundamental issue is the awareness about the condition. Awareness is the first stop towards its control. This needs education of the public as well as responsibility from the medical profession.
Once diagnosed the next step is its treatment. This consists of lifestyle modification (non-drug treatment) alone or in combination with the drug treatment. Anti-hypertensive treatment entails indefinite medication and therefore even in the most developed societies drug compliance remains a serious problem. Universally speaking control rates are at best around 25-30 per cent in the developed and approximately one to ten per cent in the developing world. Some of the identifiable risk factors include high salt contents of Pakistani food, sedentary living, obesity, smoking and genetic predisposition.
The uncontrolled epidemic of hypertension warrants the urgent attention of medical profession and health workers to devise strategies for detection, treatment and control of hypertension at the community level.
This can only be achieved by consistent efforts to create awareness, develop guidelines on diagnosis and management. Another important task is to devise simple and cheep therapeutic protocols.
To meet the above challenges, the Pakistan Hypertension League (PHL) was found in 1997 and was affiliated with the World Hypertension League (WHL) in Geneva, Switzerland. Over the past eight years PHL has done tremendous work to create awareness in both public as well as the medical profession across the country. This it has done through seminars, symposiums and workshops. Both print and electronic media was used to highlight the importance of BP check and its control.
PHL also developed guidelines for Pakistani physicians on ways of detecting, diagnosing and treating hypertension as well as algorithms for quick reference of family physicians. the League has also published information booklets on hypertension for the general public. With over 250 life members, PHL has seven regional chapters that are operating in their respective territories and engaged in various activities related to BP detection and control.
PHL has so far held seven national symposiums in various cities of Pakistan. The 8th symposium at Karachi was held from 4th to 5th December, 2004. This year’s theme is Hypertension, the uncontrolled epidemic. It is hoped that the deliberations of the symposium will increase our knowledge about the subject and will enforce our efforts to achieve our objectives.
The important feature of the symposium beside the scientific programme was a grand public awareness session for general public and a pre-symposium workshop for family physicians.
The uncontrolled epidemic of hypertension needs great deal of support from media, public leaders, planners and sociologists beside the efforts of medical profession. PHL membership is open to physicians as well nonphysicians interested in this cause.
