86
VOLUME 15 NUMBER 2 • NOVEMBER 2018
DIABETES NEWS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes News
News from the 2018 Cape Town World Congress of Internal Medicine
Why hypertension matters: the silent killer
L
aunching the 2018 World Congress of
Internal Medicine (WCIM), the South
African Hypertension Society (SAHS)
hosted a media brief on the importance
and urgency of detection and management
of hypertension. ‘Findings from global and
South African cohorts show critically low
awareness of hypertension...’ This message
from Dr Martin Mpe, president of the SAHS,
underscores the fact that hypertension is
the most important preventable cause of
morbidity and mortality worldwide.
1
The importance of blood pressure as a
risk factor for cardiovascular disease is long
recognised. Hypertension is causally linked
to stroke, myocardial infarction, end-stage
kidney disease, congestive heart failure,
peripheral vascular disease and blindness.
Inadequate control of blood pressure is
responsible for 60% of strokes globally
and 30% of ischaemic heart disease.
1
Hypertension is also related to dementia
and sexual dysfunction.
Treatment adherence (medicine, diet,
lifestyle) to control hypertension is crucial
and Dr Mpe noted that ‘...poor adherence
is of no benefit and is the same as doing
nothing,’ with only one-third of treated
patients achieving target. It is, however,
problematic that the target population
that should benefit from advances in
hypertension treatment are not even aware
of their blood pressure levels.
There are no symptoms of hypertension,
‘the silent killer’, and this can hinder
diagnosis. Sub-Saharan Africa has a burden
of 73% undiagnosed hypertension.
1
In 2010, 40% of South African adults
older than 25 years showed measured
hypertension.
2
South African demographic
and health survey figures from 2016
indicate a prevalence of hypertension of
46% in women and 44% in men older
than 15 years.
3
Awareness is the gateway to improved
blood pressure control. The International
Hypertension Society (IHS) introduced May
Measurement Month in 2017, to raise
awareness of the importance of measuring
blood pressure. Prof Alta Schutte, president
of the IHS, elaborated on the survey
outcomes. Of 1.5 million people screened
from 89 countries (including South Africa)
during May 2018, 18.4% were found to
havehighbloodpressure thatwasuntreated,
and 40.4% of those on treatment were not
controlled to target (unpublished data).
South African data from the 2017 survey
shows that 56% of those on treatment are
not adequately controlled.
4
Our older population
While increasing age is a risk factor for
hypertension, and although the size
of the older population is increasing,
relative global prevalence of hypertension
continues to climb. Prof Neil Poulter,
Oxford, UK, points out that lifestyle is
key in the prevention and management
of hypertension. As populations develop,
there is a shift in lifestyle towards reduced
physical activity, an increase in alcohol and
tobacco consumption, unhealthy eating
habits, using too much salt and being
overweight, all of which are risk factors for
hypertension.
5
With 1.56 billion people predicted to
have hypertension by 2025, the urgency
to detect and manage this condition
is paramount for non-communicable
disease management. Prof Brian Rayner,
Hypertension Institute, UCT, recommends
that individuals be encouraged to know
their own blood pressure numbers. Blood
pressure monitoring is a simple procedure,
using many validated devices available
on the market. Servier Pharmaceuticals
sponsored
the
May
Hypertension
Awareness campaign and an educational
video for patients and practitioners on how
to correctly measure blood pressure.
Source: DeNovo Medica
www.denovomedica.comReferences
1.
Chow CK, Teo KK, Rangarajan S,
et al
. Prevalence,
awareness, treatment, and control of hypertension
in rural and urban communities in high-, middle-,
and low-income countries.
J Am Med Assoc
2013;
310
(9): 959–968.
2. Day C, Groenewald P, Laubscher R,
et al
. Monitoring
of non-communicable diseases such as hypertension
in South Africa: Challenges for the post-2015 global
development agenda.
S Afr Med J
2014;
104
(10):
680–687.
3. National Department of Health, Statistics South
Africa, South African Medical Research Council.
South Africa demographic and health survey
2016: Key indicators
.https://www.statssa.gov.za/publications/Report%2003-00-09/Report%20
03-00-092016.pdf.
4. Beaney T, Schutte A, Tomaszewski M,
et al.
May
Measurement Month 2017: an analysis of blood
pressure screening results worldwide.
Lancet Glob
Health
2018;
6
(7): e736–e743.
5. Poulter NR, Prabhakaran D, Caulfield M.
Hypertension.
Lancet
2015;
386
(9995): 801–812.