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Hypertension: A silent killer of today and tomorrow

Apr 07, 2013

The World Health Organisation (WHO) should be complemented for focusing this year on high Blood Pressure as the theme of World Health Day, writes Dileep Mavalankar, Director of the Indian Institute of Public Health (IIPH).

Dileep Mavalankar

This year WHO supported world health day – 7th April – theme is High blood Pressure. It is one of the most widely prevalent diseases in the world. About of third of adult population of the world suffers from it and High BP.

It leads to many complications including heart disease; stroke (paralysis), kidney failure and blindness. High BP contributes to 50% of death from heart disease and stroke. In India the prevalence of High BP is about 23% of adult population and is rising.

With rapid westernization, increase in junk food eating habits of young urban and rural Indians and increase in consumption of traditional ‘Namkeen’ and pickles and ‘Papad’ all of which also has lots of salt, blood pressure is slated to rise  in India in near future.

Other reasons for increasing BP in India is rising obesity, smoking and stress of modern and urban life. Traditions and traditional ways of life are rapidly breaking down and pace of life is very rapidly changing with increasing mobiles, news channels and traffic jams as well as economic uncertainty – all leading to increasing stress. India is rapidly becoming a capital of diabetes and the combination of high BP and Diabetes is even more deadly – and the rapid rise in diabetes in India will only add fuel to already burning fire of high BP.

On the other hand our health care system is ill prepared for diagnosing and treating high BP epidemic. We have only one or two public General Practitioner for each Primary health center which covered a population of 30,000. Many Auxiliary Nurse-midwives (ANMs) do not know how to take BP properly and those who know take it only for pregnant women.

Our PHCs have very meager supply of BP medicines if at all. There is no health education on how to prevent or manage high PB through government health departments. There is a National Non-communicable disease (NCD) control program, but it is just in its infancy. Most of the money allocated for this program in the 11th FYP was not even programmed let alone used. Even though high BP is such an important problem there is no single officer dedicated to lead program of prevention and management of high BP at national level. There is a common program officer for all NCDs.

States are even further un-prepared, no state to has a programme officer for high BP. The result is that half of the people with high BP in India do not even know that they have this silent killer disease. They can land up with Stroke, sudden death or kidney failure.

WHO should be complemented for focusing this year on high BP as the theme of World Health Day. The management of high BP is simple if done early. High BP can be diagnosed by an ANM and treated by them under guidance of a PHC medical officer or GP. How can India rapidly develop the capacity and program for screening of high BP and its management? First step is to re-train all ANM, and male health workers to measure blood pressure and identify people with high BP.

Second step is to increase supply of medicine for high BP at PHCs and urban health centers. Third steps is to develop standard national or state level protocols for management of high BP. Fourth step is to launch massive health education campaign via mass media to create the community awareness about this silent killer.  Lastly health departments have to develop an appropriately staffed and skilled division at national and state levels to design and manage the national program for high blood pressure. Country should also think how to involve the private providers, the ASHAs and other health staff in managing high BP in the community.

Some innovating thinking like setting up BP measuring kiosks at airports, rail and bus stations and major officers of government will help creates awareness and improve detection of high BP.Unless it is done urgently, we should be ready to see our children develop early heart disease and strokewith unimaginable loss of national income and growth potential. We as an aspiring superpower cannot afford not to address this impending epidemic of high BP.

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