High blood pressure – or hypertension – is often seen as a ‘lifestyle disease” that is common in urban areas where risk factors such as unhealthy diet, lack of physical activity & exercise, smoking and stress are common. However, findings from a baseline survey conducted by Aga Khan University in ten rural areas of Thatta, released on May 17, World Hypertension Day, point to the disease being a public health threat in rural areas as well.
One in three adults in Pakistan are already living with high blood pressure, according to statistics from the World Health Organization. The study noted a similar prevalence in rural areas with one in five adults over the age of 40 living with hypertension.
The baseline survey was conducted as part of an ongoing multi-country collaborative trial called COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka).
High blood pressure (BP) is a major risk factor for heart disease, stroke and kidney disease. Those living with higher levels of BP are at a greater risk of an early death.
The baseline survey also found low awareness of the disease with six out of ten people suffering from high blood pressure not knowing that they had the disease. Even those taking medication were at a high risk of health complications associated with hypertension since the survey found that more than seven out of ten people on anti-hypertensive drugs continued to suffer from uncontrolled blood pressure.
Nearly 90 per cent of individuals in the study were only taking a single blood pressure drug. However, effective control of blood pressure requires many patients to take more than one anti-hypertensive medication on doctor’s advice. Moreover, the study found that just under half of all patients (48 per cent) were not taking their medicines regularly which also increased their vulnerability to the disease. These findings indicate inadequate management of hypertension in the rural areas.
“We found a prevalence of uncontrolled hypertension of 71 per cent in rural Pakistan which is higher than the other two collaborating countries: Sri Lanka at 57 per cent and Bangladesh at 53 per cent,” said Dr Imtiaz Jehan, associate professor at AKU and the principal investigator of the COBRA-BPS study in Pakistan. "Controlling blood pressure can be the single most important way to prevent the rising rates of heart disease and deaths in the country. We must focus on how to prevent new cases and on ways to improve existing hypertension management care.
“Our next plan of action is to use insights from the ongoing research to determine pragmatic solutions that can be integrated into public healthcare systems thereby saving the most lives,” adds Dr Jehan.
The control and prevention of non-communicable diseases (NCDs) 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.
“With the growing burden of non-communicable diseases in Pakistan, this trial seems timely to furnish evidence that will inform much-needed NCD programme planning which will improve the performance of health systems,” said Dr Sameen Siddiqui, chair of the department of community health sciences at AKU.
The principal investigator of the three-country study Dr Tazeen Jafar from Duke National University of Singapore Medical School said: "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 COBRA-BPS trial has been funded by the UK Department of International Development, Medical Research Council and The Wellcome Trust.