Hypertension a bigger pandemic?

PRESYON 4: Results of Hypertension Prevalence Survey

Hypertension, a bigger pandemic?




Manila. June 16, 2021. The COVID-19 pandemic has affected the lives of people around the world. Extreme conditions and fatalities continue to strike us beyond the health measures being imposed. Even so,  from the  press conference by the Philippine Heart Association Council on Hypertension held on June 16, 2021, the council pointed out that beside COVID-19, the real pandemic lies on the increasing prevalence of hypertension  in the Philippines.

Cardiovascular diseases including heart attacks and strokes are the number one cause of death in the world with over 17.79 million (IHME Global Burden of Disease). In the Philippines, heart diseases and hypertension are included in the ten leading causes of death in 2019 (Philippine Statistics Authority). Hypertension or high blood pressure is a strong driver of cardiovascular disease along with other risk factors: diabetes, high-cholesterol, overweight, physical inactivity, and smoking.

Complications of uncontrolled hypertension can lead to severe health problems, increase the risk of heart disease, stroke and most of the time death. According to Global Statistics on hypertension, over 1.5 billion adults are at risk for cardiovascular disease by 2025.

2021 Nationwide Hypertension Survey Results

Out of 111M Filipinos, who are hypertensive – 37% adults; 4% 12-18 year-old age group

Hypertension A bigger pandemic
Dr. Don Robespierre C. Reyes, Head of the ER Services UST Hospital, Head, PHA Cardiopulmonary Resuscitation Core Group, and the Editor-in-chief of My Heart PH
Hypertension, a bigger pandemic

PRESYON 4 objectives is to primarily determine the prevalence of hypertension in the country focusing on the age group with the inclusion of the adolescents from 12 years old and above, regardless of sex, health condition, and the socio-economic status of households. The report also assessed the awareness, the control rate, and treatment profile. The study was done on January 2021 and was completed April 2021 with 2,786 respondents from 13 regions including NCR. See figure 1.

Hypertension_A bigger pandemic_03_fig1
Fig.1: Dr. Jorge A. Sison, Consultant in the Adult Cardiology at the Makati Medical Center and the Past Head of the Cardiology Section, Medical Center Manila

Report of Dr. Jorge A. Sison, cardiologist, “the survey has seen a progressive rise in the prevalence of hypertension in the Philippines. But the awareness on how to continuously control blood pressure rates, what treatments need to be done and compliance remains low.“ Presyon 4 showed 58% have acquired end organ damage and stroke related to uncontrolled hypertension.

In a 2013 survey, Presyon 3 – Regional Hypertension Prevalence in the Philippines showed the top 3 regions: Western Visayas in Region 6 (35%), Central Luzon in Region 3 (34%), and Metro Manila – NCR (33%). See figure 2. The study concluded that there is a need to include the adolescent population.

Dr. Aurelia G. Leus, cardiologist, said that the prevalence of hypertension globally is increasing with 3.5% of children having hypertension and 2.2% – 3.5% children having elevated blood pressure, both on primary hypertension  and secondary hypertension or with underlying medical conditions. Higher rates of hypertension is seen among children and adolescents who are overweight and obese.

Presyon 4 – Regional Hypertension Prevalence in the Philippines (2021) showed the highest prevalence seen in regions: Ilocos in Region I (51%), Western Visayas in Region VI (43%), and Cagayan Valley in Region II (42%). See figure 2. With 8 years interval, the study concluded that it has seen a drop in Central Luzon (31%) but NCR remains with 33% prevalence

Hypertension A bigger pandemic
Fig. 2:. Regional Hypertension Prevalence in the Philippines. Comparison from 2013 to 2021.

 

Demographics

In comparison, the prevalence of hypertension in adolescents (12-18 years old) in 2013 was only 1%. By 2021, hypertensive increased to 5%.

Location based hypertension prevalence in 2013 indicators showed urban with 53% and rural with 47% . While in 2021, urban slightly decreased by 51% and rural reached 49%. Progressively increasing but not an ideal.

Data shows that hypertension is no longer a disease associated with the rich but of the middle class.  See figure 3.

Hypertension A bigger pandemic
Fig. 3: Hypertension Prevalence vs. Socio-Economic Class

Adults 18 years old and above who receive anti-hypertensive treatment are at 67%, while 33% with no medication. Uncontrolled blood pressure with or without medications are at 64%. Hypertensives checked their blood pressures at the health center (45%), home (25%), clinic (17%), hospital (8%) and others (mostly neighbors)*9%). With 468 respondents. At home, hypertensives monitor their blood pressure with digital – arm (44%), digital – wrist (17%), aneroid (16%), mercury (7%) and others (15%). 

According to Dr. Roberta Marie N. Cawed-Mende, cardiologist, as of February 2021, hypertension and heart diseases are the main cause of death in the Philippines even when COVID-19 is actively spreading (Philippine Statistics Authority).  

Hypertension A bigger pandemic
Causes of Deaths in the Philippines (PSA) with Dr. Roberta Marie N. Cawed-Mende

Overview

The abstract of the survey shows the prevalence of hypertension in the Philippines among adults is 37%, with male (52%) and female (48%) while the adolescent is 5%, with male (68%) and female (32%), none receiving treatment. Both adult and adolescent hypertensives have higher BMI, waist circumference, and central obesity rate. 

BP measurement in children is recommended to be done annually starting at 3 years old but younger and at every health care visit if with certain risk factors for early hypertension. Lifestyle modification should be initiated in all children with hypertension.

As recommended by Dr. Leus: 

  • DASH (Dietary Approach to Stop Hypertension
  • Weight loss intervention especially in those obese and overweight
  • Reduction in salt intake
  • Avoidance of alcohol and tobacco smoke 

If pharmacologic treatment is warranted, based on limited studies in children as to efficacy, safety and cost, recommended initial drugs include: ACE inhibitor (Enalapril, Captopril), ARB (Losartan, Valsartan), or Calcium channel blocker (Amlodipine).

Only 19% are aware of having hypertension and those unaware at 18%. Blood Pressure (BP) control rate is at 36%. Among adult hypertensives, treatment rate is 67%. With treatments, hypertensives are on monotheraphy (68%) using ARB as the most common drug, In summary the highest compliance are those with beta-blockers. 61% on medications are uncontrolled with 13% are non-compliant with their medications. End organ surveillance showed abnormal ECG in 57%, abnormal ABI in 36%, and microalbuminuria in 11.5% in adult hypertensives.

Hypertension A bigger pandemic
Hypertension, a bigger pandemic – Panel (clockwise): Dr. Don Robespierre C. Reyes, Ms. Jing Castaneda, Dr. Jorge A. Sison, Dr. Aurelia G. Leus, Dr. Orlando R. Bugarin, and Dr. Roberta Marie N. Cawed-Mende

Significance

The survey was done during the pandemic. An indication that the surge may be caused by the pandemic, but hypertension is already increasing with or without the pandemic. Both COVID-19 and hypertension need to be contained. The implications of these results suggest that hypertension deserves an equal and appropriate attention with COVID-19. The panel was asked if the pandemic is really causing the surge of hypertensives. COVID-19 has and is still making an impact on the physical inactivity or limit of movement, people have no choice but to stay home, can be attributed to lifestyle change and diet consumption, while staying at home, people divert their interests to food. A lot of people experience weight gain,  chances are they forget to take care of health. Death rate for hypertension is higher than COVID-19. Likewise, hypertension is the real killer. 

Steps to take

It’s a lifestyle disease that creates an impact on the family. It can be connected to a family affair, by trying to be a model to your children through having a healthy eating habit and lifestyle check. Experts advise that avoidance is the key, start them young for them to avoid future risks of hypertension. To do more advocacy focusing on awareness. To encourage Filipinos to have their blood pressure check.

Dr. Sison once suggested to “DepEd to educate the young, not just through washing of hands but to include awareness to start them early. Like to educate them not to smoke so it would not create future health problems, learn to drink water (most of them consume excessive sweet beverages), to practice a healthy lifestyle, and to eat fruits and vegetables. Hopefully to have healthier adults.” He reiterates, mentioning the awareness to Sen. Villar, who was under the Committee of Health then. Eventually it was set aside because of other priorities. “We need to have an active drive to remind them.

Hypertension is a traitor disease, a frightening  modern killer that can lead to heart diseases and the worst stroke and heart attack. People should take it seriously, hypertension is another pandemic. Not only adults but even the young people are prone to be at risk.

Preventive measures:

To prevent complications, keep your blood pressure in the normal range. Healthy lifestyle and medications can help lower the blood pressure. 

  • Maintain a healthy weight. For overweight, regular exercise, gradual diet or weight loss are necessary to keep your weight down.
  • Reduce sodium intake and limit processed food. Maintain a healthy diet.
  • Reduce caffeine and alcohol intake.
  • Quit or refrain from smoking.
  • Exercise more often.
  • Manage stress level by doing moderate exercise, mind exercise, yoga, or meditation.

 

Programs of Philippine Heart Association  (PHA)

In line with the advocacy, the Philippine Heart Association is urging Filipinos of all ages to support their programs and initiatives.

52100

Let’s Do 52100 daily!”  movement

5 Serving of fruits and vegetables

2 Hours of screen time

1 Hour of moderate physical activity

0 No to sugar, sweetened beverages

0 No to smoking, no to secondhand smoke

 

FitHeart Minute (FhM)

Doing the one-minute exercise every hour is good for the heart. Dedicating one minute of your time every walking hour to pocket workouts sounds sensible. 

FhM is a brainchild of PHA President Dr. Nannette Rey in collaboration with fitness Coaches Jim and Toni Saret. “We don’t want to come off as too pushy. The one-minute-every-hour habit is doable. It is a practical alternative for people who are not capable of walking 10,000 steps a day as what the Sneakers Friday (SF) requires. FhM is a spin-off of SF,” Dr. Rey said. 

 

References:

Council on Hypertension, Philippine Heart Association

Corbridge Group, Phils. 

Philippine Statistics Authority

Prevalence of Hypertension and Prehypertension among adolescents. J Pediatrics 2007

IHME Global Burden of Disease

Philippine Heart Association. 52100. Retrieved June 2021 from: https://www.philheart.org/index.php/be-involved/our-advocacies/52100

Philippine Heart Association. (2018. July-August 2018). Fit Heart Minute. Issue of MyHeartPh. Retrieved June 2021 from: https://www.philheart.org/index.php/be-involved/our-advocacies/fit-heart-minute

Madel, R. (2020, February 6). Blood Pressure Readings Explained. Retrieved June 2021, from Healthline: https://www.healthline.com/health/high-blood-pressure-hypertension/blood-pressure-reading-explained

 

READ other topics:

Essential Things to do During COVID-19 Enhanced Community Quarantine

Things to do with the new normal – Post ECQ

 

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