Afew days ago, local and global health care organisations came together to find new ways of effectively ending Hypertension - an emerging health issue resulting in serious chronic health consequences such as myocardial infarction, stroke, heart failure.
 Dr. Chamari Pandithage |
That these conditions can develop without any warning signs or symptoms whatsoever, as the pressure gradually increases in the body, make it still more alarming. According to health officials, Prevention is the key to avoid these complications, who warn that undetected and untreated they can lead to early loss of life. They also emphasise that, if detected early and treated with the locally available resources and treatment methods, most patients can lead longer quality lives.
The Sunday Observer spoke to Dr. Chamari Pandithage Medical Coordinator of Suwa Diviya, an organisation that has long been spearheading campaigns to reduce hypertension and related health issues , to find out more on how to prevent this silent killer disease and how to manage it in patients already afflicted with this condition.
Excerpts
Q. World Hypertension Day was observed on May 17. According to recent studies including an island- wide study conducted in 2014, said to be the first self reported survey by the Census and Statistics Dept. On chronic illnesses, High Blood Pressure (HPB) topped the list followed by Diabetes, Asthma, Arthritis and Heart Disease. Is this a recent phenomenon or has HPB always been a major national health problem in Sri Lanka?
A. Sri Lanka is a lower middle-income country. It is experiencing rapid transformations associated with increased risk of hypertension, including aging, increased affluence, physical inactivity, urbanisation, and high levels of salt intake. Information on hypertension (HTN) prevalence, trends, and patterns is limited. Since 1985, only nine population-based surveys of hypertension have been published, most covering only subnational areas.. This means that nearly one in three adult Sri Lankans are hypertensive, requiring antihypertensive treatment. So this has now become a major national health problem. The latest data from 2019 shows that nearly 1 in 3 adults in Sri Lanka have high blood pressure. However, a study done in the same year shows that 1 in 2 adults in Sri Lanka are living with abnormal blood sugars in the urban areas. So currently both of these conditions have increased with diabetes surpassing the other Non Communicable Diseases (NCD’s).
Q. Is obesity and being overweight a contributory cause?
A. Being overweight or obese increases your risk of developing high blood pressure as your blood pressure rises when your body weight increases. Losing weight has the biggest effect on those who are overweight and already have hypertension.
Q. Consuming too much salt? Ideally how much salt should a normal person without HPB take in his/her daily diet?
A. WHO recommends that adults consume less than 5g (just under a teaspoon) of salt per day.
Q. For those with HBP how many teaspoons are permitted? None? Five grams per day?
A. The American Heart Association recommends an ideal limit of no more than 1.5 g per day for most adults especially for those with high blood pressure. Even cutting back by 1 g a day can improve blood pressure and heart health.
Q. What about sugar? Is taking excessive sugar leading to diabetes also a cause?
A. You gain weight when you take in more calories than your body needs. Sugary foods and drinks contain a lot of calories. When you’re overweight you are at an increased risk of getting type 2 diabetes.
Q. Eating Oily fried foods and too much carbs - do they have a link?
A. Yes, avoiding refined carbohydrates will keep a check on your blood sugar levels. Also avoiding the saturated fat found in fatty meats, full fat dairy and fried foods will keep your risk at bay of developing heart disease as persons living with type 2 diabetes have an increased risk of getting heart disease.
Q. What are the established risk factors and emerging risk factors for BO?Are these causes the same in this part of the world as in the more developed Western world?
A. There is an exceptionally strong relation between unhealthy diets and income, with low-income countries having the highest score for consumption of unhealthy diet compared with HICs. Food items like bread, meat and meat products, milk and dairy products, instant noodles, condiments, salted preserved foods, and bakery products contribute to high-salt diets in LMICs. Tobacco also kills around 8 million people a year, many living in low and middle income countries.
People in poor neighbourhoods are also more likely to be exposed to air pollution—an emerging risk factor for hypertension. Once diagnosed with hypertension, people with low socioeconomic status are less likely to afford out-of-pocket expenses for antihypertensive medication, leading to uncontrolled hypertension and early development of complications. So I feel we’re at an increased risk of getting HTN living in LMIC than in a HIC.
Q. Age wise, who are those most at risk of getting hypertension?
A. The prevalence of hypertension increases with advancing age to the point where more than half of people 60–69 years of age and approximately three-fourths of those 70 years of age and older are affected.
Q. What about children?
A. High blood pressure is more common in youth with obesity and renal disease is the most common cause of secondary hypertension in children.
Q. It has been under found that in Colombo alone around 3.3 percent children less than 15 were pre diabetic. Is this true? If so, how did this happen?
A. Yes this is true and it is rising. Risk factors that may increase your child’s risk for developing pre-diabetes include large birth weight, eating high fat processed foods, having a parent/sibling with pre-diabetes or Type 2 diabetes, lack of physical activity and larger than average waist circumference.
Q. How do you diagnose HPB?
A. Your health care provider will use a blood pressure test to see if you have higher-than-normal blood pressure readings. The reading is made up of two numbers, the systolic number and the diastolic number. These numbers are measures of pressure in mm HG (millimeters of mercury). Your blood pressure is checked using a cuff, usually placed around your arm. It’s important that the cuff fits. If it’s too big or too small, blood pressure readings can vary. The cuff is inflated using a small hand pump or a machine. High blood pressure is diagnosed if the blood pressure reading is equal to or greater than 130/80 mm Hg. A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate occasions.
Q. What is the ideal BP a normal person should have?
A. A normal blood pressure level is less than 120/80 mmHg
Q. If one is already having BP, what is the level he/she should strive for? Is there a cut off point when the level enters a dangerous zone?
A. Ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg. If your systolic is over 180 or your diastolic is above over 120, you may be having a hypertensive crisis.
Q. What happens when a person’s BP exceeds permissible levels reaching very high levels?.
A. At high levels there may be blurred vision, headaches and abdominal pain. Stroke, heart attacks, fits and kidney failure may occur over a period of days or weeks.
Q. Can HPB be measured at home or only in a hospital setting?
A. You don’t always have to go to your doctor’s office to have your blood pressure checked; you can monitor your own blood pressure at home. This is especially important if your doctor recommends that you monitor your blood pressure on a regular basis.
Q. What are the most serious adverse health impacts of High Blood Pressure?
A. It raises your risk of heart attack and stroke, it makes you more likely to develop heart failure, it can increase your risk of getting diabetes, it can cause kidney damage, you are more likely to develop vision problems, and you could develop sexual dysfunction.
Q. Q Since you mentioned eating healthy diets is important, describe what a healthy meal is.
A. A healthy, balanced diet includes foods from all 5-food groups: fruit, vegetables, grains, proteins and dairy. Foods high in sugar, saturated fat and salt aren’t healthy.
Q. Prevention? How do you prevent developing hypertension?
A. Practise the following healthy living habits. Eat a Healthy Diet. Choose healthy meal and snack options. Keep yourself at a healthy weight. Be physically active, do not smoke, limit how much alcohol you drink and get enough sleep.
Q. Treatment wise- what is the usual treatment for a person with hypertension?
A. Firstly, clinicians should treat adults with hypertension to a standard blood pressure target of less than 140/90 mm Hg to reduce the risks of all-cause mortality and cardiovascular mortality.
This is a strong recommendation based on high-quality evidence. There are three main classes of medication that are usually in the first line of treatment for hypertension: 1. Calcium Channel Blockers 2. Angiotensin Converting Enzyme inhibitors and Angiotensin Receptor Blockers 3. Diuretics.
Q. How do you treat a person at pre-hypertension stage?
A. There are three things you can do: have a more active lifestyle, make healthy food choices, and, if needed, take your medicine every day as it is prescribed. With prehypertension, some people can bring blood pressure down to normal through weight loss, exercise and other changes for a healthy lifestyle.
Q. The theme chosen for this year’s World Hypertension day is “Measure Your Blood Pressure Accurately, Control It, Live Longer.” What is its significance and relevance to Sri Lankans?
A. In Sri Lanka, one in three adults is hypertensive. A large proportion of these are undiagnosed. So this theme is very timely, significant and relevant to us.
Q. How will our health officials meet this challenge?
A. Currently aggressive management of HTN is required. Once diagnosed with hypertension, people with low socioeconomic status are less likely to afford out-of-pocket expenses for antihypertensive medication, leading to uncontrolled hypertension and early development of complications. Therefore in a country like Sri Lanka prevention is key.
That is where programs like what we offer at Suwa Diviya come to the forefront. We offer prevention awareness and screening sessions to corporates and other workplaces. We hope to start a programs for children also soon.
Public-private collaborations to mitigate the risk of NCD’s are vital now more than ever before.
Q. Gaps you see on proper care for hypertension patients?
A. A recent analysis of individual-level data from 1.1 million adults in nationally representative samples in 44 LMICs reports that among those with hypertension, 26 percent had never had their BP measured, 39 percent had been diagnosed with hypertension before the survey, 30% had been treated, and only 10 percent had achieved control of their hypertension.
I feel the need of the hour is to find those who are still undiagnosed.
Q. How would you like to fill them?
A. Increasing awareness and screening is vital. For improved control of hypertension, the individualised, targeted approach requires interventions to adequate treatment and control.
Q. Your message to the readers?
A. Hypertension is the leading risk factor for death in the world. Prevention is key. Changes in lifestyle can prevent hypertension and other non communicable diseases.