- A silent epidemic of high blood pressure affects over 3 million people in Pakistan, with a shocking 23% prevalence among individuals aged 18-29.
- Lifestyle factors such as sedentary behaviour, poor diet, and physical inactivity contribute significantly to hypertension risk among the Pakistani population.
- Obesity, identified in 70% of the population, and unhealthy dietary patterns, with over 80% of adolescents having poor diets, are prevalent risk factors.
In the hustle and bustle of our modern lives, health often takes a backseat.
Astonishingly, over 3 million people grapple with this condition in the country. However, the true cause for alarm lies in the fact that the prevalence of high blood pressure among individuals aged 18-29 stands at a staggering 23%.
High blood pressure (hypertension), is not just a concern for the elderly. The youth are increasingly falling victim to this silent threat.
What Causes Hypertension/ High Blood Pressure?
You may face a higher risk if you:
-
1. Have a Sedentary Lifestyle and Its Toll
In an era dominated by screens and sedentary occupations, physical activity has taken a backseat. The lack of exercise coupled with prolonged hours spent in front of screens contributes significantly to the rise in high blood pressure among the youth.
2. Dietary Habits: The Unseen Saboteur
Fast food and processed snacks have become staples in the diet of many young Pakistanis. The excessive intake of sodium, unhealthy fats, and sugary delights wreaks havoc on blood pressure levels, setting the stage for hypertension.
3. Stress: The Modern Menace
The fast-paced lifestyle and societal expectations often subject the youth to unprecedented levels of stress. Chronic stress triggers hormonal imbalances, directly impacting blood pressure regulation.
4. More Underlying Medical Conditions
Diabetes is not the only underlying condition that can lead to high blood pressure. Other diseases include:
- long-term kidney infections
- sleep apnoea – where the walls of the throat relax and narrow during sleep, interrupting normal breathing
- glomerulonephritis – damage to the tiny filters inside the kidneys
- narrowing of the arteries supplying the kidneys
- hormone problems – such as an underactive thyroid, an overactive thyroid, Cushing’s syndrome, acromegaly, increased levels of the hormone aldosterone (hyperaldosteronism), and pheochromocytoma
- lupus – a condition in which the immune system attacks parts of the body, such as the skin, joints and organs
- scleroderma – a condition that causes thickened skin, and sometimes problems with organs and blood vessels
Medicines that can increase your blood pressure include:
- the contraceptive pill
- steroids
- non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen, aspirin and naproxen
- some pharmacy cough and cold remedies
- some herbal remedies – particularly those containing liquorice
- some recreational drugs
- some selective serotonin-noradrenaline reuptake inhibitor (SSNRI) antidepressants
Adopting healthier lifestyle habits can potentially decrease your likelihood of developing high blood pressure and contribute to lowering it if already elevated.
Controlling High Blood Pressure
1. Embrace Physical Activity
A sedentary lifestyle is a silent accomplice to high blood pressure. Incorporating regular physical activity, be it jogging, cycling, or even brisk walks, can significantly contribute to maintaining optimal blood pressure levels.
2. Mindful Eating: A Recipe for Health
Swap out processed foods for wholesome, nutrient-rich alternatives. Incorporate fruits, vegetables, and whole grains into your diet to ensure a balance that supports your cardiovascular health.
3. Stress Management Techniques
Khadija Arif emphasizes the importance of stress management in controlling hypertension. Practices such as meditation, yoga, and mindfulness can be powerful tools in mitigating stress and promoting overall well-being.
Risk Factors for Hypertension in Pakistan
A meta-analysis of 37 studies identified 46 factors significantly associated with hypertension in the Pakistani population. The three most frequently cited factors were advanced age (15 occurrences), gender (14 occurrences), and BMI (9 occurrences). A national Non-Communicable Disease (NCD) survey assessing risk factors in two major provinces of Pakistan revealed a high prevalence of hypertension, with respondents exhibiting either low fruit and vegetable consumption (96.5%), low physical activity (46%), being overweight (26.3%), or obesity (14.9%).
Obesity:
The correlation between BMI and hypertension has been observed in multiple studies, particularly with a BMI exceeding 23 kg/m2. Akram J et al. reported a 70% prevalence of obesity in Pakistan, significantly associated with hypertension (p = 0.0003). They also noted higher obesity rates among Pakistani women than men. The global rise in childhood obesity has contributed to a 2 to 4% increase in hypertension prevalence in children. However, limited data exists on obese children and hypertension in Pakistan.
Unhealthy Diet:
The Pakistan Adolescents Schools Survey 1 reported that over 80% of adolescents in Pakistan had unhealthy diets [30]. While studies in high-income populations link diets high in red meat, fatty foods, and sweet desserts to increased blood pressure, few studies have explored dietary patterns in Asian populations. A study in Pakistan reported a decrease in hypertension with yoghurt and seafood dietary patterns but found no statistically significant effect of high-fat and sugar dietary patterns on hypertension [32].
Physical Inactivity:
A WHO study revealed that 82.8% of boys and 87.3% of girls aged 13‐15 were not sufficiently active. Another study reported that 54.3% of Pakistani adolescents were physically inactive, with factors like schools lacking playgrounds, female gender, and lack of parental support correlating with physical inactivity. A survey in Karachi found that increased physical activity was significantly associated with a lower risk of hypertension, with men being more active than women.
The rise of sedentary lifestyles, increased office jobs, conversion of agricultural lands to factories, and transportation facilities hindering physical activity contribute to hypertension risk factors in 21 countries.
Literature reports established risk factors for hypertension, including lifestyle behaviours, physical inactivity, unhealthy diet, obesity, low socioeconomic level, and smoking. This review aligns with existing literature, emphasizing obesity, unhealthy diet, and decreased physical activity, which are linked to low socioeconomic levels.
Blood pressure monitoring practice in Pakistan: According to the European Society of Cardiology (ESC) 2018 guidelines, auscultatory or oscillometric semiautomatic or automatic sphygmomanometers are preferred for measuring BP. While oscillometric devices are recommended for office BP, resource-poor countries like Pakistan continue to use the mercury sphygmomanometer despite its challenges. Variations in blood pressure monitoring practices in clinic settings and the prevalence of white coat hypertension are reported in studies. Post-clinic BP is introduced as a potentially more reliable method of monitoring BP.
Control rate of hypertension in Pakistan: Hypertension control is generally poor in most Asian countries. Developed countries like Canada have higher rates of controlled hypertension (65%) in primary care settings compared to developing nations like Pakistan, where the control rate is only 6%. Adherence to antihypertensive therapy, the number of medications, and medication compliance significantly impact control rates. Tertiary care settings show better control rates, with factors such as age, gender, and education influencing controlled hypertension.
Challenges in controlling hypertension: Barriers to hypertension control in Pakistan include the absence of screening programs, limited access to healthcare facilities, poor provider-patient communication, and high treatment costs. A qualitative study identified various barriers, including lack of disease seriousness insight, knowledge gaps, healthcare system limitations, inadequate health education, and financial constraints. Higher education levels, family history of HTN, fear of premature death, and previous comorbidities positively influence self-care behaviour.
Medication nonadherence: Adherence to prescribed treatments is influenced by factors such as education level, number of medications, and comorbidities. Studies in rural South Asia and urban Pakistan show an independent relationship between a low wealth index and poor medication adherence. Reasons for nonadherence include travel, symptom control, gender, duration of hypertension, and regular BP monitoring.
Lack of universal health care (UHC):
In Pakistan, the majority of healthcare costs (60%) are borne by households, with over 52% coming from out-of-pocket (OOP) expenditures, primarily on medications. The lack of UHC contributes to higher uncontrolled hypertension rates in rural areas compared to other countries with UHC.
Lack of knowledge about hypertension: Studies highlight poor knowledge scores among hypertensive patients in Pakistan. Lack of disease seriousness insight, deficient knowledge, healthcare system limitations, and financial constraints act as barriers to proper NCD control. Educational interventions have shown positive effects on medication adherence and blood pressure control.
Evidence on the management of hypertension in Pakistan: Recommended treatments for hypertension involve thiazide diuretics, ACEIs, or CCBs. Discrepancies exist between international guidelines and the prescribing patterns in Pakistan, with beta-blockers being extensively prescribed despite guideline recommendations. Limited intervention trials in Pakistan emphasize the importance of combined community education and healthcare provider education for hypertension control.
Stay tuned to WOW360.
