On May 17th 2019, academia, civil societies, leading organisations in public health policy, and health care providers, will join the rest of the international community in recognising World Hypertension Day. Also joining this tapestry of stakeholders, will be many people living with hypertension and its catastrophic events, heart attacks and strokes, as well as the families, friends, and caregivers, who are helping their loved ones cope with the disabilities associated with these sudden events. Very importantly, in this group, will also be people who have lost their brothers, aunts, workmates or acquaintances, as a consequence of this silent killer. The observance of World Hypertension Day can not therefore be just another day to acknowledge a longstanding enemy, it must be a time of much deeper reflection on methods and policies to rapidly stem the loss of just over 10 million people per year who succumb to this fate.
Hypertension discriminates shamelessly. It targets low-to-middle income countries, that are the most vulnerable to other natural disasters, such as tsunamis and hurricanes, and who must face difficulty decisions of prioritising health care costs, with providing clean drinking water for their citizens.
Hypertension is racist. It targets, disproportionately so, the communities of the African diaspora, whether by creating an enabling environment that facilitates the social determinants of risk factors, like unhealthy foods high in sodium, limited environments for physical activity, or smoke friendly public spaces. It has been argued that these enabling environments that are conducive to the social determinants of ill health, result in unhealthy decisions and an addiction for risky additions.
Of the people living with hypertension, only half of them know they have it; the major first barrier to successful blood pressure control has been awareness. Treatment can only be achieved if people are aware they have high blood pressure. From 2017, the International Society of Hypertension (ISH) has launched an international programme to raise awareness about high blood pressure, around May 17th, World Hypertension Day, with May Measurement Month. This programme aims to screen newly diagnosed cases of elevated blood pressures, and over 2.7 million people have been screened in two years! Barbados, through civil society organisations like the Heart & Stroke Foundation of Barbados Inc., and the Barbados Defence Force, will again team up under the theme “Drilling Down the Numbers, Because I Say So!!”. This highlights the nature of both the enemy, and the necessary combat response needed for a public health threat to our very sustainability! It also borrows the ISH’s strategy of using the strong influence that our children have in all of our lives, in motivating their parents, teachers, neighbours etc., to get their blood pressure checked, Because I Say So!
Once aware of the diagnosis, people living with high blood pressure should implement lifestyle changes to reduce their blood pressure. These include a reduction in added sodium (salt) intake, getting approximately 150 minutes of physical activity every week, smoking cessation, and reduction in harmful alcohol intake. These lifestyle changes must be emphasised at all stages of the attack against high blood pressure.
Despite these their best efforts, however, the majority of people living with high blood pressure will require tablets (pills) to reduce their blood pressure, and will need to continue this protection for their entire lives. On and off treatment of high blood pressure may put these people at a higher risk for stroke. Your insurance policy only protects you from a natural disaster when it’s current and active, even if it only expired yesterday!
Healthcare providers – doctors, nurses, pharmacists, dieticians and psychologists – all have a responsibility of creating the most enabling environment for people living with hypertension to reach their target blood pressure, including motivating them to continue their efforts at healthier living and reminding them to take their medication everyday, to guarantee protection, should a hurricane strike!
Scientists, practitioners and civil societies, also have a moral and professional responsibility to:
- Lobbying for healthier environments- sugar sweetened beverage and cigarette taxation
- Taking steps to urgently address the high prevalence of childhood obesity – 1 in 3 children in Barbados are overweight or obese
Establishing the availability of core medications and a simplified management protocols and algorithms. The use of larger, more complex (and much longer!!) guidelines are robust academic and peer reviewed documents, but they’re only effective if used. Update of these guidelines remains low. This is clearly demonstrated in the WHO Global Hearts Initiative, which aims at providing a collection of toolkits that aim to implement both public health and individual patient interventions.
- Establishing a cleaner pathway of converting the new evidence into the care of people living with hypertension
My wish for World Hypertension Day 2019 is that we step back from data on rates, risks and ratios, to step back from the search for new drugs and gadgets used to treat and measure high blood pressure, and to move into the homes and lives of the many people living with hypertension, from the street corners in New York, to the remote villages in Uganda, and ask ourselves “why does it all matter?”.
It matters to us in Barbados, because all of our very strong and successful efforts made to improve the lives of our people post independence, are under the real threat from an enemy, who has become so cliché, that its best defense has been familiarity.
Get out there and have your blood pressure checked, and if you’re already living with high blood pressure, keep at it!! This isn’t just your individual effort, entire communities are here to support your efforts, and to live healthier because our children say so!