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High blood pressure reaching epidemic proportions in country

KARACHI: The researchers of the Aga Khan University (AKU) have found that high blood pressure is turning into an epidemic in the country, and it could only be controlled by training the physicians and by providing healthcare education to people in their homes through community health workers.

The AKU researchers, after conducting a lengthy technical research, also found that reduced blood pressure over the long term can lead to a one-fifth decline in deaths from heart disease in urban populations. The study that was carried out for about two years and was funded by the Wellcome Trust, UK and based on a two-pronged approach.

Over 1,300 40-year-old individuals with high blood pressure were chosen from 12 urban communities in Karachi. The subjects for this study were selected from New Karachi, Rehmani Garden, Aurangabad, Korangi, Saghir Centre, Villayatabad, Saudabad, Safoora Goth, Orangi Town, Liaqatabad, Ramswami and Bhutta Village and were divided into clusters.

One group was assured to receive home-based health education from community health workers and other group was referred to trained general practitioners.

Also there were those who received both these options, while a fourth control group received no intervention.

These groups were regularly examined over a two-year period. “We saw that patients in groups receiving both health workers’ care, as well as trained general practitioners’ care, had the greatest improvement in blood pressure,” said Dr Tazeen Jafar, AKU professor of medicine and community health sciences, and the lead investigator on the study.

He said these results could help develop a cost-effective strategy to prepare a sustainable and implementable nation-wide blood pressure control programme.

High blood pressure is the leading cause of death in high and low-income countries. According to the National Health Survey of Pakistan, conducted from 1990 to 1994, around 21.5 percent of the urban population over 15 years of age - that is one in every three people over the age of 45 years - suffers from high blood pressure.

Despite convincing evidence that lowering blood pressure decreases death and disability from heart disease, strokes and kidney disease; blood pressure control rates remain poor in most developing countries.

In Pakistan, poor health literacy, unhealthy lifestyles and a lack of awareness contribute to the high blood pressure problem, which is further compounded by a poorly regulated and disorganised health care system. The AKU study shows that existing infrastructure can be used to provide cost-effective and implementable solutions to tackle a growing pandemic in the region.

“The strategy proposed by our trial is simple and can easily be integrated into the existing health care system of Pakistan and many other developing countries: one general practitioner training session per year coupled with health education at home by trained community health visitors,” said Dr Jafar. “This is encouraging because it provides hope of success if similar strategies are implemented in other countries facing the pandemic of high blood pressure and associated morbidity and mortality.”

Community health workers were trained to provide knowledge on the harmful effects of hypertension and to share options for non-medical interventions to prevent and control blood pressure and heart diseases. “We talked to families about weight loss strategies, the need to exercise, how to quit smoking, how to reduce salt and saturated fat intake, and to increase the amount of fruit and vegetables in their diet. In some cases, this was new knowledge for the communities. In other cases, all they needed was advice on changing their lifestyles,” a participating health worker explained. The education was delivered at three-monthly intervals to match the frequency of visits by government lady health visitors. amar guriro

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