AKU study reveals hypertension growth in rural Sindh

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

 A study exploring the risk posed by high blood pressure in rural areas of Sindh has found alarmingly low awareness of the disease, and numerous cases of uncontrolled blood pressure despite the use of medication.

High blood pressure, or hypertension, is often seen as a ‘lifestyle disease’ that is common in urban areas where risk factors such as stress, poor eating habits and a lack of exercise are common. 

However, findings from a baseline survey conducted by Aga Khan University in 10 rural areas of Thatta, released on May 17, World Hypertension Day, point to the disease being a public health threat in rural areas as well. 

One in three adults in Pakistan is already living with high blood pressure, according to statistics from the World Health Organization. The study noted a similar prevalence in rural areas with one in five adults over the age of 40 living with hypertension. 

Researchers also found low awareness of the disease with six out of ten people suffering from high blood pressure not knowing that they had the disease. Even those taking medication were at a high risk of health complications associated with hypertension since the survey found that more than seven out of ten people on anti-hypertensive drugs continued to suffer from uncontrolled blood pressure.

The baseline survey was part of an ongoing multi-country collaborative trial Primary Care Strategies to Reduce High Blood Pressure: A Cluster Randomized Trial in Rural Bangladesh, Pakistan and Sri Lanka.  

One of the striking findings of the study was the prevalence of inadequate treatment for hypertension as nearly 90 per cent of individuals in the study were only taking a single blood pressure drug. 

However, effective control of blood pressure requires most patients to take more than one anti-hypertensive medication. 

Moreover, the study found that just under half of all patients (48 per cent) were not taking their medicines regularly which also increased their vulnerability to the disease. High blood pressure is a major contributor to heart disease, the leading cause of death in Pakistan, and can also lead to the onset of other non-communicable diseases such diabetes, stroke and kidney disease. 

“Hypertension has reached epidemic levels in Pakistan and other South Asian countries,” Dr Imtiaz Jehan, associate professor at AKU and principal investigator of the study in Pakistan, remarked. 

“We must focus on how to prevent new cases and on ways to improve existing hypertension management care. We plan to use insights from our ongoing study to determine which solutions can be integrated into the public healthcare systems thereby saving the most lives.” 

The control and prevention of non-communicable diseases (NCD) such as hypertension is a global health priority with targets under goal 3 of the Sustainable Development Goals calling for a one-third reduction in deaths caused by such diseases by 2030. 

“The growing burden of non-communicable diseases in Pakistan means that this trial will generate evidence that is likely to inform much needed NCD care program planning which will improve the performance of health systems,” Dr Sameen Siddiqui, chair of the department of community health sciences at AKU, observed. 

The study’s principal investigator Professor Tazeen Jafar from Duke National University of Singapore Medical School said: "The majority of individuals with treated hypertension have uncontrolled blood pressure in rural Pakistan, Sri Lanka and Bangladesh with significant disparities among and within countries. Urgent public health efforts are needed to improve access and adherence to anti-hypertensive medications in disadvantaged populations in rural South Asia.” 

The study in Pakistan is part of a multi-country research collaboration called COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka).