KOCHI: Although Kerala stands at the forefront of health status among other states in India, Hypertension (HTN) and elevated cholesterol are widely prevalent in adults compared to other states.
According to a publication of ‘Diet and Nutritional Status of Urban Population of India’ (2015-16), HTN is found in 38.6% men and 31.4% women of Kerala’s adult population.
On the other hand, elevated cholesterol seems to be on the rise with 33.5% men and 38.5% of women having the disease. Despite leading in indexes like lifespan (76.4 yrs.), neonatal mortality (7), infant mortality (10), maternal mortality (47), literacy level (95%) and institutional delivery (99.9), Kerala still has a long way to go.
Major researches on HTN
HTN is one of the non-communicable diseases (NCDs) which is growing as a threat to global health. NCDS accounted for 72% of all deaths in 2016, of which nearly half were in people younger than 60 years of age. This increase is attributed to a change in food habits, sedentary behaviour, and unhealthy lifestyles. A new survey in various states in India showed that the adult prevalence of HTN was 25.3% in India. If we look into the urban Vs rural population, it showed that 20-40% of adult urban population and 12-17% rural population were hypertensives.
In a recent study conducted by Harvard University, USA using health data of 1.3 million Indian adults between 2012 and 2014 revealed that the incidence of HTN and Diabetes Mellitus are high among middle-aged and elderly people across all geographic areas and socio-economic groups in India. In the elderly, HTN is estimated at 80% and it is found to be the root cause of heart attacks, strokes, and renal failure.
Another interesting finding in a survey conducted by the ‘Sree Chitra Thirunal Institute’, Thiruvananthapuram is that 69% of people in Kerala consume more salt (250g/month) as against the recommended dose of 150g/month. Almost one-third of our total population has HTN and 80% of the Keralites do not take enough fruits and vegetables.
Existing impact of HTN
The global burden of death due to HTN is 1.6 million/year and the number of DALY (Disability Adjusted Life Years) is 33.9 million. As per the ‘Fourth National Health Screening Committee,’ there are approximately 110 million Hypertensives in India. In China, where the prevalence of HTN is high (37.2%), only 25% of hypertensive patients are receiving proper treatment and in only 5.7%, the hypertension is properly controlled. The average intake of salt per day in China is also three times more (12-18 g/day) than the recommended quantity (12-18 g/day).
In 2016 the ‘Lancet Commission on Hypertension’ launched a call to action and a life course strategy, to address the global burden of raised BP on current and future generations. Among other key actions, systematic education to patients, doctors and the general public, empowerment, and expansion of the available workforce, management of blood pressure through task sharing are seen as effective control procedures.
Remedy for HTN
Reduction of salt intake and proper consumption of vegetables and fruits are well known to reduce the incidence of HTN. Self-monitoring of blood pressure is better than clinical monitoring for better control of HTN. A nationwide survey by the ‘National Nutrition Bureau’ to assess the urban nutritional status has also revealed that Indians consume far less than the recommended quantities of essential vitamins and nutrients.
While the recommended consumption of green leafy vegetables is 40 gm/day, the real consumption by an Indian is only 24 grams, and Keralites consume the least quantity of green leafy vegetables. Kerala also belongs to one of the top six Indian states having the highest number of smokers in urban areas, and smoking is also a proven risk factor HTN. If you are a middle-aged or a senior citizen, please check the blood pressure at the earliest. Even if your systolic blood pressure is above 200 mm of Hg, HTN will be asymptomatic in the beginning.
Prof. K P Poulose
Principal Consultant in Medicine S U T Hospital, Pattom, Thiruvananthapuram
(The views expressed by the author are his own)