New study says targeted population based approaches work in tackling hypertension epidemic
Hypertension, or high blood pressure, is the leading risk factor for heart disease.
A new paper in the Journal of the American College of Cardiology argues that targeted and population based strategies are ideal recipe for blood pressure control. This paper is part of an eight-part health promotion series where each paper will focus on a different risk factor for cardiovascular disease.
According to a recent World Health Organization (WHO) report, hypertension is the third biggest risk factor for heart disease in India. High blood pressure is directly responsible for about 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.
As per NFHS data, about 9% women and 14% men falling in the age bracket of 15-49 years, suffer from hypertension nationally.
The prevalence of hypertension globally is high and continues to increase. High blood pressure is associated with an increased risk of stroke, ischemic heart disease, heart failure and noncardiac vascular disease, as well as other conditions.
“Hypertension is caused by a combination of genetic, environmental and social determinants,” said Robert M. Carey, MD, professor of medicine at the University of Virginia School of Medicine and lead author of the paper.
“While genetic predisposition is nonmodifiable and conveys lifelong cardiovascular risk, the risk for hypertension is modifiable and largely preventable due to a strong influence by key environmental and lifestyle factors.”
He added: “While genetic predisposition is nonmodifiable and conveys lifelong cardiovascular risk, the risk for hypertension is modifiable and largely preventable due to a strong influence by key environmental and lifestyle factors.”
Modifiable lifestyle factors, which are gradually introduced in childhood and early adult life, include being overweight/obesity, unhealthy diet, high sodium and low potassium intake, insufficient physical activity and consumption of alcohol. Many adults do not change their lifestyle after being diagnosed with hypertension and sustaining any changes that are made can be difficult.
Social determinants such as race and socioeconomic status are also risk factors for hypertension.
According to the authors, prevention and control of hypertension can be achieved through targeted and population-based strategies. The targeted approach is the traditional strategy used in health care practice and seeks to achieve a clinically important reduction in blood pressure for individual patients.
The population-based strategy aims to achieve small reductions that are applied to the entire population, resulting in a small downward shift in the entire blood pressure distribution. Studies have shown that the population-based approach may be better at preventing cardiovascular disease compared with the targeted strategy.
Factors preventing successful hypertension control include inaccurate blood pressure measurement and diagnosis of hypertension, lack of hypertension awareness and access to health care, and proper hypertension treatment and control. Low rates of medication adherence is also a common problem.
“Challenges to the prevention, detection, awareness and management of hypertension will require a multipronged approach directed not only to high-risk populations, but also to communities, schools, worksites and the food industry,” Carey said.