Since 2005, the World Hypertension League (WHL) has promoted World Hypertension Day on 17 May annually. The primary aim of this health event is to increase the awareness of the dangers of high blood pressure (BP) or hypertension in populations around the world.
The call to action for World Hypertension Day is to promote best practices to stay up to date with global standards in hypertension prevention, and measurement and to standardize these measures globally in order to monitor the prevalence within countries and across countries. Key stakeholders in the health space are set to achieve the goal for hypertension control in Africa by the year 2030.
In 2022 the focus is on low- to middle-income countries (LMICs) as the consequences of hypertension in these countries lead to poor health outcomes, in particular making individuals more vulnerable to heart disease, strokes, and other circulatory diseases.
Given the increase in the prevalence of hypertension in LMICs in the past 25 years, interventions for hypertension control are urgently needed. One in three people are aware of their hypertension status with only approximately eight percent of them having their blood pressure controlled. It has been projected that three-quarters of all adults with hypertension will be living in LMICs by 2025.
As hypertension is the leading preventable risk factor for cardiovascular disease in Africa and globally, it is important to stimulate all countries to address social impact, disease burden, and costs for national health systems. Hypertension is responsible for 13% of all deaths worldwide.
In South Africa, more than one in three adults live with high blood pressure and it is responsible for one in every two strokes and two in every five heart attacks. High blood pressure is known as a ‘silent killer’ because there are rarely any symptoms or visible signs to warn you. That is why more than 50% of people with high blood pressure are unaware of their condition.
Hypertension is defined as the high persistent force of the blood flowing through the blood vessels. Fluctuations in blood pressure are normal, which is why it is only diagnosed when it remains high on several occasions or when it is dangerously high on one occasion.
It is important to understand the pathophysiology of hypertension as this will prove the urgency of appropriate action to address it.
When trying to understand the risk factors for hypertension in relation to LMICs, it is a combination of both risk factors that have already been well established and those that are not sufficiently emphasized. Established risk factors include unhealthy diets, which in LMICs can be associated with affordability and availability of healthy foods, as well as physical inactivity.
Another prominent risk factor is tobacco smoking, with over 80% of all tobacco users residing in LMICs. Furthermore, excessive alcohol consumption has been linked to hypertension and episodic heavy drinking has been found to be high in LMICs. With LMICs facing a double burden of malnutrition (i.e. coexistence of undernutrition and overweight/obesity), obesity is another established risk factor which can lead to kidney disease which in turn, can increase blood pressure.
Less emphasised risk factors include environmental factors such as low green space, high pollution and urbanisation, all of which have a link to raised blood pressure and are found to be in a worse state in LMICs compared to the rest of the world. Green space is found to reduce environmental stressors such as air pollution.
Another less emphasised but highly driven risk factor for hypertension, especially in low-income countries, includes social and commercial determinants of health.
Social determinants refer to unequal conditions in which individuals are born, grow, live, work, and age and often influence risk factors for hypertension, mainly unhealthy diet, physical inactivity, and tobacco and alcohol consumption.
Examples of commercial determinants of health that are found to influence unhealthy behaviours such as smoking include certain industries that promote products harmful to health.
Familial hypertension (FH) is often also not discussed as an important risk factor. FH is a rare, genetic form of hypertension caused by mutations in particular genes, many of which help control the balance of fluids and salts in the body and affect blood pressure.
The heritable component of blood pressure has been documented in familial and twin studies suggesting that 30%-50% of the variance of blood pressure readings being attributable to genetic heritability (explained by genes) and about 50% to environmental factors.
Similarly, familial aggregation of hypertension is well recognised, and a family history of hypertension has been associated with increased risk and earlier onset of hypertension, highlighting the importance of genetic factors in hypertension.
Amongst the known risk factors, evidence states that the likelihood of high blood pressure increases with age. Nearly eight in 10 South Africans over 55 years have high blood pressure (The Heart and Stroke Foundation of South Africa).
The HSFSA, therefore, urges the public and especially those over the age of 45 years, to get screened and know their numbers. Furthermore, the message stands simple and strong to adhere to medications prescribed by your doctor should you already be diagnosed.
Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa (HSFSA), states that ‘given the number of South Africans who are unaware of their BP it is crucial that individuals over the age of 40 take their BP readings regularly as a way to empower themselves to act if they are indeed hypertensive’.
She continues to remind the public about the importance of adhering to the recommended drug treatment provided by your doctor and to also manage behavioural risks, such as smoking, excessive salt intake, and lack of physical activity, to control hypertension.
Behaviour modification can aid in both preventing or managing high blood pressure. A crucial change is eating a healthy, balanced diet to maintain a healthy weight. The HSFSA endorsement program is something that can help achieve this.
The Heart Mark endorsement program is part of ongoing efforts by the HSFSA to reduce the number of deaths in South Africa from preventable heart disease and stroke. The endorsement programme forms part of a health-enabling environment offering you a tool which makes choosing healthier foods easier.
It is a guaranteed way to buy food lower in salt, lower in sugar, lower in saturated fats, and higher in fibre.
This becomes especially important during the management of hypertension, as high salt intake is linked to increased blood pressure. The World Health Organization (WHO) recommends no more than 5g (one teaspoon) of salt intake from all sources, per day. Other important behaviour changes include being physically active, not smoking tobacco nor inhaling secondary smoke, managing psychological stress, and limiting alcohol intake.
Don’t be afraid to adopt simple changes in health-seeking behaviour that can help prevent hypertension and keep hypertensive patients in good health. It is important to accurately measure your blood pressure, know your blood pressure status, and control it by taking your medication to live longer even if you are hypertensive.