Daily Times

KARACHI: A new study exploring the risk posed by high blood pressure in rural areas of Sindh has found alarmingly low levels of awareness, and numerous cases of uncontrolled blood pressure despite the use of medication.

High blood pressure – or hypertension – is often seen as a ‘lifestyle disease’ associated with urban areas, where risk factors such as stress, poor eating habits and a lack of exercise are common. However, findings from a baseline survey conducted by Aga Khan University in 10 rural areas of Thatta, released on May 17, on the occasion of the World Hypertension Day, point to the disease being a public health threat in rural areas as well.

According to the statistics maintained by the World Health Organisation, one in three adults in Pakistan are living with high blood pressure.

The AKU study notes a similar prevalence in rural areas of Sindh with one in five adults over the age of 40 living with hypertension.

Researchers have also found low levels of awareness with six out of 10 people suffering from the disease had yet to be diagnosed and put on treatment. Even those taking medication are at a high risk of health complications associated with hypertension since the survey has found that more than seven out of 10 people on anti-hypertensive drugs continue to suffer from uncontrolled blood pressure.

The baseline survey was a part of an ongoing multi-country collaborative trial, Primary Care Strategies to Reduce High Blood Pressure: A Cluster Randomized Trial in Rural Bangladesh, Pakistan and Sri Lanka.

One of the striking findings in Sindh is the prevalence of inadequate treatment for hypertension as nearly 90 percent of cases were only taking a single blood pressure drug. However, effective control of blood pressure requires most patients to take more than one anti-hypertensive medication. The study has also found that just under half of all patients (48 per cent) are not taking medicines regularly, which increases their vulnerability to the disease.

High blood pressure is a major contributor to heart disease, the leading cause of death in Pakistan, and can also lead to the onset of other non-communicable diseases such diabetes, stroke and kidney disease.

“Hypertension has reached epidemic levels in Pakistan and other South Asian countries,” says Dr Imtiaz Jehan, an associate professor at AKU and the principal investigator for the study in Pakistan.

“We must focus on ways to prevent new cases and to improve existing hypertension management care. We plan to use insights from our ongoing study to determine which solutions can be integrated into the public healthcare systems thereby saving the most number of lives.”

The control and prevention of non-communicable diseases (NCD) such as hypertension is a global health priority with targets under goal 3 of the Sustainable Development Goals calling for a one-third reduction in deaths caused by such diseases by 2030.

“The growing burden of non-communicable diseases in Pakistan means that this trial will generate evidence that is likely to inform much needed NCD care programme planning which will improve the performance of health systems,” says Dr Sameen Siddiqui, the chair of the Department of Community Health Sciences at AKU.

The study’s principal investigator Professor Tazeen Jafar from Duke National University of Singapore Medical School says, “The majority of individuals with treated hypertension have uncontrolled blood pressure in rural Pakistan, Sri Lanka and Bangladesh with significant disparities among and within countries. Urgent public health efforts are needed to improve access and adherence to anti-hypertensive medications in disadvantaged populations in rural South Asia.”

The study in Pakistan is part of a multi-country research collaboration called COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka.

Published in Daily Times, May 18^th 2018.