Keep Your Hypertension Under Control

A healthy lifestyle saves millions of lives worldwide and it is under our control. According to global health estimates, 7 out of 10 deaths worldwide are due to Non-Communicable Diseases (NCDs), and more than fourths/fifths of all deaths occur in low- and middle-income countries (WHO, 2018). Among NCDs, cardiovascular deaths top the list of mortality (17.9 million, 44 per cent of NCD deaths) followed by cancer (9 million, 22 per cent). It is estimated that among all-cause deaths in 2016, 66 per cent were attributable to NCDs in Nepal (WHO, 2018). 

Hypertension, also known as high blood pressure is one of the leading causes of cardiovascular diseases worldwide. Since the last three decades, cases of hypertension doubled to around 1.28 billion people worldwide and two-thirds of them live in low and middle-income countries (WHO, 2023). For such an increase, growth in the world population and aging are the primary reasons. It has been estimated that around 700 million people with hypertension worldwide still remain untreated and only 21 per cent of those diagnosed and treated have their blood pressure under control (WHO, 2023). The prevalence of raised blood pressure in Nepal is 24.5 per cent for both sexes, slightly higher among males than females (NHRC, 2019).

No warning signs

High blood pressure often has no warning signs or symptoms. Therefore, people with the condition do not realise that they have hypertension. The only way to know about hypertension is to measure blood pressure.  Consistent high blood pressure is associated with coronary artery disease, stroke, heart failure, vision loss, chronic kidney disease, and dementia. Blood pressure can easily be measured at home, clinic, or hospital. The first and third leading cause of death worldwide is heart disease and stroke owing mainly to high blood pressure. In most cases, the causes of hypertension are unknown. However, blood pressure rises as age increases. Primary or essential hypertension accounts for 90-95 per cent of cases when the cause is unknown and probably due to genetic or environmental factors. 

There are several known lifestyle factors that increase the risk of high blood pressure such as excessive salt intake, insufficient physical activity, diets high in trans-saturated fats, low intake of fruits and vegetables, overweight or obesity, risky alcohol intake, and tobacco use. The remaining 5-10 per cent of cases are due to known causes and are known as secondary hypertension and risk factors are prehypertension, diabetes, chronic kidney disease, narrowing of the kidney arteries, and endocrine disorders.

Lifestyle-related risk factors are modifiable and substantial improvements in mortality due to NCDs are achievable. A survey in Nepal showed that the mean daily salt intake for people aged 15+ 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 take more than seven grams of salt a 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 are widely produced industrially from vegetable fats and are used heavily in processed and fast foods. Trans-fats have been implicated in 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). The country targets a 10 per cent relative reduction in the prevalence of insufficient physical activity by 2025. The STEPS survey 2019 revealed that the 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 the nation 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 readily 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 four litres for males and one litre for a female among 15+ years old (WHO, 2016). A survey found that the percentage of people who currently drink alcohol is 23.9 per cent (NHRC, 2019). National NCD targets the reduction of 10 per cent of the harmful use of alcohol by 2025.

Lifestyle modification

The present level of promotional activities is not sufficient to address the modifiable risk factors for high blood pressure to achieve the targets set for 2025. Therefore, an extensive advocacy campaign is called upon to reduce the consumption of salt, trans-unsaturated fats, risky alcohol consumption, and reduction in tobacco use. 

It has been proved in other parts of the world that increasing tax on tobacco decreases consumption. Therefore, it is called upon the regulatory authority to impose additional excise on tobacco products. A similar approach to alcoholic products and highly processed and fast foods is also expected to decrease their consumption. It is important to know that all of those risk factors for high blood pressure are modifiable. It is the responsibility of all stakeholders and healthcare professionals to take the issue of high blood pressure seriously and extensively promote lifestyle modifications for better and healthy living.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)