High Blood Pressure: In the context of Nepal

High blood pressure is now growing as a major public health challenge around the globe.  One in every three individuals worldwide is hypertensive.(2) Previously it was supposed to be the problem of elite, old and western people. Now, astonishingly almost double the numbers of hypertensive people live in developing countries like Nepal than those live in developed countries.(3)  According to WHO, prevalence of high blood pressure is highest in some low-income countries in Africa where nearly half of total adults are being affected.(2) Even in Nepal, a recent study in rural Kathmandu showed that prevalence of high blood pressure has been increased by three fold in 25 years.(4) Preponderance of evidences suggest the development of inevitable worse scenario in Nepal in near future.

Source: http://www.resperate.co.uk/blog/journal/world-heart-day-to-target-cvds-hypertension/

High blood pressure is one of the most important causes of premature death worldwide. The salient killer has a potential contribution for heart attacks, strokes and kidney failure.(2) A study revealed that 69% of people who had a first heart attack and 77% of people who had a first stroke had co-existence of high blood pressure.(3) It is also a major risk factor for cardiovascular diseases that account one fourth of total death in Nepal. The conglomeration of high blood pressure with other cardiovascular risk factors is making the condition worse and increasing death toll. Similarly, hypertensive persons are more predisposed to develop to a modern day epidemic, diabetes.(5)

There are several risk factors for developing blood pressure. Family history of high blood pressure, advancing age and gender are some predetermined unalterable predisposing  factors for high blood pressure.(5) If parents have high blood pressure, their offspring are also genetically susceptible to it. Similarly, men are at more risk for suffering from high blood pressure until 45 years of age. However, the main concerning culprits for developing high blood pressure are some modifiable risk factors like lack of physical activity, overweight, poor diet with excessive salt intake, harmful use of alcohol, tobacco consumption and stressful life. (2)

Regular physical activities can reduce the risk of high blood pressure.(6) Just brisk walking or jogging for half an hour on five days of week can be helpful for preventing it. Such physical activities will also be beneficial for lowering down the systolic blood pressure by 4 to 9 mm of Hg in hypertensive people.(6, 7) Moreover, cycling, hiking, swimming and aerobics are also equally supportive for burning out the calories and getting rid of obesity, a precursor to high blood pressure and diabetes like chronic disorders. However, sedentary lifestyle, lack of interest in outdoor activities, use of passive mode of transportation and increased urbanization have played a substantial role for reducing the physical activity level in people.(2) More than 14 percent of Nepalese are now living the insufficiently physically active life.(8) In last three decades, Nepalese mean body mass index is also gradually shifting upward with proportional increment in non communicable diseases.(8)

Similarly, healthy food choices can halt the process of generating high blood pressure. Food rich in nutrients, having low amount of saturated fat and cholesterol, containing abundant fibers with vegetables and fruits has the salubrious effect on blood pressure.(6) Unfortunately, the newly developed fast food culture in Nepal has engulfed the values of healthy diet. Easy accessibility, conveniency, taste, falsified advertisement and lack of awareness about fast foods are the some misleading reasons behind its preference. Ironically, well to do families are also adopting the pizza, hamburger and chips culture for the sake of westernizing themselves. But these foods have deleterious impact on health. More importantly, the canned and processing foods contain particularly high amount of added salt. The well known fact is the excess amount of salt intake raises the blood pressure and is also dangerous to heart.

Likewise, heavy and regular drinking of alcohol has a causal relationship with high blood pressure. It not only increases the blood pressure, also contributes for high triglycerides, obesity and other cardiovascular diseases. Available evidence suggests the limitation of alcohol consumption will substantially reduce blood pressure.  Nonetheless, high numbers of Nepalese are indulgent to alcohol.

The attitude and practices on tobacco consumption are neither so satisfactory in spite of ratification of the Framework Convention on Tobacco Control (FCTC) and initiation of some anti-tobacco programs. Nearly one third of Nepalese smokes tobacco daily. The prevalence of smoking among Nepalese women is the highest in South Asia.(8)

 Excess alcohol and tobacco consumption level may often relate with individual stress coping mechanism. But stress itself has a direct effect on blood pressure. Though the long term impact is still unknown, it can surge the blood pressure temporarily.(5)

Admittedly, tremendous challenges are waiting ahead in controlling the epidemic of high blood pressure. It necessitates the international organizations, public health agencies, national authorities and related stakeholders initiating the population based policy development. Their collaboration for advancing policies, strengthening capacity and taking action for promotion of healthy behaviours and prevention of high blood pressure is earnestly in demand. Multisectoral involvement and community participation are also equally important for assuring effective public health action and its implementation.(9) In the meantime, WHO has already come out with an idea to raise the awareness of the causes and consequences of high blood pressure. National and local authorities should also stop being nonchalant over the issues and, instead, be responsible to create enabling environments for healthy behaviours. Government should strictly enforce the standardizing and mandating food labeling policy, implement WHO’s Global Strategy on Diet, Physical Activity and Health, and extend anti-tobacco policies and program.(10)

Finally, every individual should have the responsible healthy behavoiur. Nothing is as highly influential as one’s behavior for determining his/her health condition. Eating a balance and low salt diet; developing a habit for regular physical exercise, yoga and meditation; avoiding tobacco and harmful use of alcohol; and maintaining a healthy body weight are the unanimously recommended healthy behaviours and lifestyle for preventing and protecting oneself from high blood pressure.

 

 References:

1.            World Health Organization. World Health Day 2013.  [cited 2013 April 7]; Available from: http://www.euro.who.int/en/who-we-are/whd/world-health-day-2013.

2.            World Health Organization. About high blood pressure.  [cited 2013 March 20]; Available from: http://www.who.int/campaigns/world-health-day/2013/event/en/index.html.

3.            American Heart Association. High Blood Pressure; 2013.

4.            Vaidya  PR, Pandey MR. Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu. Indian Heart J. 2012 Mar-Apr;64(2).

5.            American Heart Association. Understand Your Risk for High Blood Pressure.  [cited 2013 March 20]; Available from: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp.

6.           U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES/National Institutes of Health. DASH Eating Plan. National Heart, Lung, and Blood Institute; 2006.

7.            Kokkinos PF, Giannelou A, Manolis A, Pittaras A. Physical Activity in the Prevention and Management of High Blood Pressure. Hellenic Journal of Cardiology. 2009;50:52-9.

8.            World Health Organization. Noncommunicable diseases country profiles 2011.

9.            The World Bank. NCDs POLICY BRIEF-NEPAL: The World Bank, South Asia Human Development, Health Nutrition, and Population; 2011.

10.          Keller I. WHO Global Strategy on Diet, Physical Activity and Health. World Health Organization.

 

 


My education includes training in medicine, public health, clinical research, biostatistics and health response in complex emergency. I have more than seven years of experiences in health research (Survey, Case control studies, Randomised Controlled Trials (RCT), Health Policy and Systems Research). My areas of expertise also include the project management particularly in health sector. I have also experience and interest to work in health emergency in large population in disaster setting.

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