Prof. Dr. Shyam P Lohani

The modification of people’s lifestyle saves millions of deaths worldwide and most of those modifications are under the individuals’ control. According to global health estimates by WHO (2018), 7 out of 10 deaths (71 per cent, 41 million) worldwide is implicated to Non- Communicable Diseases (NCDs) and more than four/fifths of all deaths that occur in low and middle-income countries are due to essential NCDs (stroke, cancer, COPD and diabetes). Cardiovascular deaths top the list of mortality (17.9 million, 44 per cent of NCD deaths) followed by cancer (9 million, 22 per cent of NCD deaths). It is estimated that among 183 thousand deaths in 2016, 66 per cent (121,000) were attributable to premature mortality from NCDs in Nepal (WHO, 2018). Cardiovascular disease accounts for 30 per cent deaths followed by 10 per cent respiratory disease, 9 per cent cancer, and 4 per cent diabetes.

Causes
Hypertension or high blood pressure is one of the leading causes of cardiovascular diseases in the world. Around 1.13 billion people worldwide in 2015 have hypertension and most of them live in low and middle-income countries. High blood pressure usually has no warning signs or symptoms; therefore, people with the condition do not realise that they have hypertension. The only way to know about it is to measure blood pressure. The consistently high blood pressure has been associated with and the major risk factors for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.
The blood pressure is measured with two numbers, one when our heart beats and another when it rests. The pressure on the blood vessels when the heart beats is called systolic pressure and at rests is called diastolic pressure. The blood pressure less than 120/80 mm of Hg is normal pressure, from 120/80 to 139/89 is pre-hypertensive and 140/90 or more is hypertension. The pre-hypertension is the condition that people having it are at risk of developing hypertension in the future. The prevalence of raised blood pressure in Nepal is 24.5 per cent for both sexes (29.8 per cent males and 19.7 per cent females) (NHRC, 2019).
The first and third leading cause of deaths worldwide is heart disease and stroke which are mainly caused by high blood pressure. In most cases, the causes of hypertension are unknown. Blood pressure rises as age increases. The primary or essential hypertension accounts for 90-95 per cent of cases when the cause is unknown and probably due to genetic or environmental causes. The lifestyle factors that increase the risk of high blood pressure are excessive salt intake, insufficient physical activity, diets high in trans-saturated fats, low intake of fruits and vegetables, being overweight or obese, excessive alcohol consumption and tobacco use. The remaining 5-10 per cent of cases is due to known causes and known as secondary hypertension. The identifiable risk factors are prehypertension, diabetes, chronic kidney disease, narrowing of the kidney arteries, endocrine disorders and use of birth control pills.
Lifestyle-related risk factors can be modified to achieve substantial improvements in mortality due to NCDs. Mean population salt intake for people aged 15+ in Nepal is 9.6 grams for males and 8.7 grams for females (NHRC, 2019). The recent guidelines recommend people with high blood pressure should not exceed 7 grams per day. Nepal targets to reduce 30 per cent relative reduction in mean population intake of salt/sodium by 2025. Trans-unsaturated fatty acids or trans-fatty acids which are widely produced industrially from vegetable fats started in the middle of the 19th century. They are used heavily in processed and fast foods. Trans-fats raise bad (LDL) cholesterol levels and lower good (HDL) cholesterol levels. Eating trans-fats increases the risk of developing heart disease and stroke.
It has been estimated that 8.2 per cent of males and 6.6 per cent of females have insufficient physical activity in Nepal (NHRC, 2019). Nepal targets a 10 per cent relative reduction in the prevalence of insufficient physical activity by 2025. The STEPS survey 2019 revealed that percentage that ate less than 5 servings of fruit and/or vegetables on average per day was 96.7 per cent (97 per cent males and 96.3 per cent females). The prevalence of tobacco use among the 15+ age group in Nepal is 28.9 per cent (48.3 per cent in males and 11.6 per cent in females) (NHRC, 2019). Tobacco products (both smoke and smokeless) are easily available and relatively cheap in Nepal in comparison to other countries in South East Asia. Nepal has set a reduction of 30 per cent prevalence of tobacco use by 15+ years old by 2025.
Per capita consumption of pure alcohol in Nepal is 4 litres for males and 1 litre for a female among 15+ years old (WHO, 2016). The recent survey found that the percentage of people who currently drink alcohol is 23.9 per cent (38.6 per cent males and 8.8 per cent females) (NHRC, 2019).

Conclusion
It is important to address the modifiable risk factors for high blood pressure to achieve targets set for 2025. We need to develop extensive promotional public health activities to reduce the consumption of salt and intake of trans-unsaturated fats in Nepal. It has been proved in other parts of the world that increasing tax on tobacco decreases the consumption. Therefore, it is called upon the regulatory authority to impose additional excise on tobacco product. A similar approach to alcoholic products is also expected to decrease its use. We should keep in mind that all of those risk factors for high blood pressure are under our control. It is the responsibility of all the stakeholders and health care professionals to take the issue of high blood pressure seriously and extensively promote lifestyle modifications for better and healthy living among the general public.