Hypertension: Silent killer, global public health crisis

Lazarus Sauti

According to a recent World Health Organisation report titled “A global brief on hypertension: Silent killer, global public health crisis 2013”, hypertension or raised blood pressure, a non-communicable disease, is a silent, invisible killer that rarely causes symptoms.

The disease already affects one billion people worldwide and, according to researchers, it currently kills nine million people every year. Furthermore, raised blood pressure is responsible for at least 45 percent of deaths due to heart disease.

Hypertension contributes to the burden of heart disease, stroke and kidney failure and premature mortality and disability. Because of this, it disproportionately affects populations in developing countries where health systems are weak.

Sadly, the prevalence of hypertension is highest in the African region. Many African countries are seeing growing numbers of people who suffer from heart attacks and strokes due to undiagnosed and uncontrolled risk factors such as hypertension.

The prevalence is high in Africa and other low- and middle-income countries because many people do not seek treatment for hypertension since it is prohibitively expensive.

But this risk does not need to be so high.

The World Health Organisation report thus puts it this way, “Hypertension can be prevented. Doing so is far less costly, and far safer for patients, than interventions like cardiac bypass surgery and dialysis that may be needed when hypertension is missed and goes untreated.”

Not addressing hypertension in a timely fashion will have significant economic and social impact in most – if not all ‑ African countries, as they are the countries that can least afford the social and economic consequences of ill health.

Without doubt, premature death, disability, personal and family disruption, loss of income, and healthcare expenditure due to hypertension, take a toll on families, communities and national finances. Dr Margaret Chan, the Director General of the World Health Organisation, says increasing public awareness is, therefore, critical in preventing hypertension, as is access to early detection.

“Raised blood pressure is a serious warning sign that significant lifestyle changes are urgently needed,” says Dr Chan.

Accordingly, Africans need to know why raised blood pressure is dangerous, and how to take steps to control it.

“They need to know that raised blood pressure and other risk factors such as diabetes often appear together,” notes Dr Chan adding that to raise this kind of awareness, countries need systems and services in place to support healthy lifestyles: eating a balanced diet, reducing salt intake, avoiding harmful use of alcohol, getting regular exercise and shunning tobacco.”

Dr Chan goes on to say: “Access to good quality medicines, which are effective and inexpensive, is also vital, particularly at the primary care level.

As with other non-communicable diseases, awareness aids early detection while self-care helps ensure regular intake of medication, healthy behaviours and better control of the condition.”

To effectively reduce hypertension and non-communicable diseases, countries must develop and implement public health policies and programmes that reduce death and disability. More so, programmes and strategies that address total cardiovascular risk need to be an integral part of national strategies for prevention and control of non-communicable diseases.

Moreover, integrated non-communicable disease programmes implemented through a primary health care approach are an affordable and sustainable way for countries to tackle hypertension.

The WHO report notes: “Health systems must propagate and promote actions at the primary care level that target the entire spectrum of social determinants of health; balance prevention and health promotion with curative interventions; and emphasise the first level of care with appropriate co-ordination mechanisms.”

Governments in Africa and other developing nations can do more by responding to the ever-growing health needs of their respective populations and the increasing costs of health services. Preventing complications of hypertension is a critical element of containing health-care costs.

It is also worth to note that prevention and control of hypertension is complex, and demands multi-stakeholder collaboration, including governments, civil society, academia and the food and beverage industry.

As noted in the WHO report: “The prevention and control of hypertension requires political will on the part of governments and policymakers. “Health workers, the academic research community, civil society, the private sector and families and individuals all have a role to play.

“Only this concerted effort can harness the testing technology and treatments available to prevent and control hypertension and thereby delay or prevent its life-threatening complications.”