Monday, June 24, 2024

Silent killer

On September 19, the World Health Organization (WHO) released its first ever global report on hypertension. The title of the report was as point-blank as they come: The race against a silent killer. The WHO report compiles data for the first time on the far-reaching consequences of uncontrolled hypertension, including heart attacks, strokes and premature death, along with substantial economic losses for communities and countries. It also contains information on the global, regional and country-level burden of hypertension and progress of control efforts. Perhaps most importantly, the report shows a way forward, by highlighting key aspects of guidance from the World Health Organization’s HEARTS: technical package for cardiovascular disease management in primary health care and the Guideline for the pharmacological treatment of hypertension in adults. These tools were developed to provide guidance for countries in establishing early detection, management, control and monitoring of hypertension as part of primary health care services. The report shows that globally, one in three individuals is affected by this silent killer ~ a stark indictment of the world’s inadequate response to this major public health threat. Four out of five people with hypertension are not receiving the necessary treatment to control it. This grim reality underscores a glaring failure on the part of nations and Governments to rein in the most significant risk factor for both death and disability, despite the ready availability of affordable medications. Hypertension, characterised by uncontrolled blood pressure (typically over 140/90), stands as a primary contributor to cardiovascular diseases, including heart attacks and strokes, making it the most prevalent cause of disease and fatality worldwide. What’s crucial to understand is that the health risks associated with hypertension extend well beyond the official clinical threshold of 140/90. They operate along a continuum, affecting even those with blood pressure readings below this threshold, particularly individuals grappling with conditions such as diabetes, obesity and habits like tobacco and alcohol consumption. This underscores the alarming underestimation of the cumulative risk posed by high blood pressure in the population. According to the WHO report, based on 2019 data, a staggering 188 million Indian adults between the ages of 30 and 79 have hypertension. Shockingly, only 37% of them have received a formal diagnosis and merely 30% are undergoing any form of treatment. A lowly 15% of individuals have their hypertension under control. In a somewhat silver lining, women seem to outperform men slightly in terms of diagnosis, treatment and control of the condition. Drawing on incomplete data from certain regions of India, a study in February 2022 found that the annual stroke incidence ranged from 108 to 172 cases per 100,000 people, with a case fatality rate of 18% to 42%. In the Global Burden of Disease report for 2019, heart attacks stood as the foremost cause of death and disability in India. Research indicates that excessive salt consumption, exceeding five grams per day, is responsible for 17% to 30% of hypertension cases. Although member States are mandated to achieve a 30% relative reduction in the average population’s salt intake by 2025, India has yet to fully embrace the WHO’s recommendations to curtail salt intake. A 2021 study conducted in four Indian States exposed alarmingly high levels of salt and sugar in packaged food items. Urgent measures, such as making front-of-pack nutrition labeling compulsory, promoting food reformulation to reduce salt content and increasing public awareness about reducing salt intake, should be promptly implemented. However, it might not be all gloom and doom on the hypertension front in India. The India Hypertension Control Initiative (IHCI), introduced in 2018, is said to have managed to enroll a significant 5.8 million hypertensive patients for treatment in 27 States as of June 2023. Notably, 48% of patients enrolled at primary health centres and 55% at health wellness centres achieved blood pressure control as of March 2021. The imperative now is to substantially expand the reach of hypertension treatment and ensure that more individuals maintain their blood pressure within healthy limits.