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Blood pressure is the force exerted by the blood on the vessels through which it flows. When this pressure is consistently high, the condition is termed as high blood pressure or hypertension. High blood pressure increases the load on the heart and blood vessels, which can eventually lead to major life-threatening cardiovascular events such as a heart attack and stroke.1

Studies reveal that a remarkably high rate of hypertension is seen in people living in low- and middle-income countries (LMICs). However, the treatment options available in these countries are inadequate, and new approaches are necessary to improve the management of this condition.2

What is hypertension, and how is it managed?

Systolic and diastolic pressures are the two numbers used to document blood pressure. Systolic blood pressure is the higher number, while diastolic blood pressure is the lower number. For a normal person, the ideal blood pressure values are 120/80 mm of Hg. Blood pressure values above 140/90 mm of Hg indicate hypertension.3 Persistent hypertension can lead to various life-threatening conditions. Significant risk factors for hypertension include being overweight, old age, smoking, excess alcohol intake and excess salt intake.3

The following methods are used for the management of hypertension:4

  • Reducing mental stress
  • Checking the blood pressure regularly
  • Treating hypertension with medications
  • Managing the medical conditions that cause hypertension

How common is hypertension in LMICs?

Previously, hypertension was known to be a disease of the affluent population. As per data, earlier, only one in five adults had hypertension in LMICs; however, studies indicate that by the year 2025, three in four adults will suffer from hypertension.5 The reason may be the lack of awareness about hypertension5 and the increase in risk factors that cause hypertension in the LMICs.4 Development, urbanisation and lifestyle changes are seemingly responsible for the growing prevalence of hypertension in LMICs.2

Why is hypertension poorly managed in LMICs?

Hypertension is often regarded as a silent killer as it silently damages your health and creates a threat to life.1 Some research studies state the possible reasons for poor management of hypertension in the LMICs as below:5,6

  • Smaller research capacity and healthcare resources in comparison to the prevalence of the condition
  • Low rate of adherence to treatment
  • Less access to implementable hypertension guidelines
  • Less availability of medicines
  • The inability of the people to afford costly medications that need to be taken lifelong
  • Variable needs of the patients depending on their cultural differences, genetic make- up and medical conditions
  • Inconsistent designs and outcomes of clinical trials for hypertension
  • Forgetfulness, leading to discontinuation of treatment

Although hypertension guidelines are available in some LMICs, the non-availability of proper resources makes the implementation difficult.5 There exist regional differences in non-adherence to treatment. For example, a study shows that people in Africa show a low percentage of non-adherence to antihypertensive therapy than in Asian countries.6 The use of traditional medicines in the LMICs is also a cause of non-adherence to treatment.6

What can be done to improve the management of hypertension in low- and middle-income countries?

Hypertension significantly increases the risk of heart, brain, kidneys and other diseases, and is also a major reason for premature death.4 The following steps can be taken to improve the management of hypertension in the LMICs:5,7

  • Development of treatment guidelines while taking into consideration the social, economic and psychological conditions in a particular region or country
  • Engagement of community and health professionals and their collaborative participation in achieving improvement in healthcare
  • Implementation of innovative salt-reduction programmes to reduce hypertension
  • Promoting the consumption of substituted salt
  • Redistribution of healthcare tasks with the help of teams consisting of doctors and non-health professionals in remote and rural areas
  • Use of mobile phones to connect patients with doctors to create awareness of hypertension
  • Use of affordable generic antihypertensive medication

There is strong evidence of poor management of hypertension in LMICs. Innovative approaches can be used for driving towards better adherence and affordability of antihypertensive medicines.7

Proper guidelines and inexpensive medicines can help to improve the management of hypertension in LMICs.

References:

  1. American Heart Association. What is high blood pressure? [Internet]. [updated 2016 Oct 31; cited 2019 Dec 17]. Available from: https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/what-is-high-blood-pressure.
  2. Lloyd Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle income countries: prevalence, awareness and control. Int J Epidemiol. 2014 Feb;43(1):116-28. doi: 10.1093/ije/dyt215.
  3. NHS. High blood pressure (hypertension) [Internet]. [updated 2019 Oct 23; cited 2019 Dec 17]. Available from: https://www.nhs.uk/conditions/high-blood-pressure-hypertension/.
  4. World Health organization (WHO). Hypertension [Internet]. [updated 2019 Sep 13; cited 2019 Dec 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.
  5. Owolabi M, Olowoyo P, Miranda JJ, Akinyemi R, Feng W, Yaria J, et al. Gaps in hypertension guidelines in low- and middle income versus high income countries: a systematic review. Hypertension. 2016 Dec;68(6):1328-1337. doi: 10.1161/HYPERTENSIONAHA.116.08290.
  6. Macquart de Terline D, Kane A, Kramoh KE, Ali Toure I, Mipinda JB, Diop IB, et al. Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries. PLoS One. 2019 Jul 10;14(7):0219266. doi: 10.1371/journal.pone.0219266.
  7. Vedanthan R, Bernabe-Ortiz A, Herasme OI, Joshi R, Lopez-Jaramillo P, Thrift AG, et al. Innovative approaches to hypertension control in low- and middle-income countries. Cardiol Clin. 2017 Feb;35(1):99-115. doi: 10.1016/j.ccl.2016.08.010.

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