HYPERTENSION

Taming the silent killer (high blood pressure)

It can be prevented. Doing so is far less costly.

In Summary

• Quit smoking; limit intake of all types of fats and replace saturated with unsaturated fats such as nuts, vegetable oils and fish; limit cholesterol intake and increase fibre intake.

• Exercise at least 150 minutes per week because it lowers blood pressure by keeping the heart and blood vessels in good condition, and limit alcohol intake.

We live in a rapidly changing environment. Throughout the world, human health is being shaped by powerful forces such as demographic ageing, rapid urbanisation and the globalisation of unhealthy lifestyles.

Increasingly, wealthy and resource-constrained countries are facing similar disease patterns, with populations in low- and middle-income countries disproportionately affected due to weak health systems.

One of the most striking examples of this shift is the fact that Non-Communicable Diseases (NCDs) such as cardiovascular disease, cancer, diabetes and chronic lung diseases have overtaken infectious diseases as the world’s leading cause of mortality.

The World Health Organisation (WHO) estimates that NCDs will cause 73 per cent of global deaths and 60 per cent of the burden of disease by 2020.

As Kenya’s population grows and the economy prospers, lifestyle changes have shifted the disease burden from infectious to non-communicable conditions. Today, NCDs, including cardiovascular diseases, account for 40 per cent of all deaths in Kenya and 50 per cent of all hospital admission. Therefore, NCDs have become a major public health concern in the country.

Globally, cardiovascular diseases account for most NCD deaths, or 17.5 million people annually, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). Of these, hypertension complications account for 9.4 million deaths every year. Thus, hypertension is a considerable public health threat.

Patients are advised to follow the Dietary Approaches to Stop Hypertension (DASH) to lower their blood pressure - the DASH diet is rich in fruits and vegetables and low in fat and sodium.

It has long been called the “silent killer” — and for good reason. In most cases it has no obvious symptoms. It is an independent predisposing factor for heart failure, coronary artery disease, stroke, renal disease, and peripheral arterial disease. It is the most important risk factor for cardiovascular morbidity and mortality. Hypertension rarely causes symptoms in the early stages and many people go undiagnosed.

In poor resource settings, those who are diagnosed with the condition may not have access to treatment and may not be able to successfully control their illness over the long term.

Some of the risk factors include high levels of blood lipids, obesity, physical inactivity, smoking and excessive alcohol use, glucose intolerance/diabetes and age.

There are significant health and economic gains attached to early detection, adequate treatment and good control of hypertension. Treating the complications of hypertension entails costly interventions such as cardiac bypass surgery, carotid artery surgery and dialysis, all of which drain individuals’ and governments’ budgets.

Hypertension can be prevented. Doing so is far less costly. The best way to protect oneself from hypertension is being aware of the factors and making changes that matter.

Patient education on the disease as well as medication and lifestyle modifications are the cornerstone of successful treatment. Empathy from the healthcare team and honouring the culture of the patient are also very important.

At an individual level the following measures are useful in preventing hypertension: Quit smoking, limit intake of all types of fats and replace saturated with unsaturated fats such as nuts, vegetable oils and fish.

Further, limit cholesterol intake, increase fibre intake as it can speed up the removal of cholesterol from the blood. Fibre is found in oats, oat bran, barley, fruits, vegetables, legumes and whole grains. Keeping Body Mass Index between 18.5kg/m² and 23kg/m² (BMI is a measure of a person's weight in relation to his height) and reducing excess weight also help lower one's cholesterol levels.

Exercise at least 150 minutes per week because it lowers blood pressure by keeping the heart and blood vessels in good condition, and limit alcohol intake.

For those already diagnosed with hypertension, blood pressure should be monitored frequently. If a patient does not achieve goal blood pressure readings, then alterations to the medicinal management of hypertension should be made.

The clinician must endeavour to balance the therapeutic effects with the side effects of drugs in order to optimise drug therapy. Behavioural modification is another evidence-based approach to improving the patient’s compliance with therapy.

Patients are advised to follow the Dietary Approaches to Stop Hypertension (DASH) to lower their blood pressure - the DASH diet is rich in fruits and vegetables and low in fat and sodium.

Patient education on the disease as well as medication and lifestyle modifications are the cornerstone of successful treatment. Empathy from the healthcare team and honouring the culture of the patient are also very important.

All members of the healthcare team (eg physicians, nurses, and pharmacists) should work together with the patient to promote lifestyle change and blood pressure control and ultimately taming this “silent killer”.

Implementation scientist based in Nairobi  [email protected]