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A deadly pressure

Hypertension leads to 9.4 million deaths each year globally. Of these, 1.1 million deaths occur in India. In Delhi too, the cases of hypertension are rising every year

Himashree Pandey, 32, lost her husband in 2016 when he suffered a stroke because of hypertension (high blood pressure). “Vikrant was just 35 years old. He was struggling with high blood pressure even before our marriage, but he was on medication for that. However, at times he used to stop taking his pills,” she says, adding, “I feel the kind of lifestyle and food habits that we indulge in today, are predominantly responsible for the rising cases of hypertension. My personal loss made me realise the gravity of the situation, which calls for immediate steps to tackle this health concern.”

Hypertension is responsible for 57% of all stroke deaths in India. According to an ICMR (Indian Council of Medical Research) report, hypertension causes 9.4 million deaths each year, worldwide — which is more than AIDS, road accidents, diabetes and tuberculosis combined —making it the most important risk factor for death and disease burden.

The report also mentions that many of those who died were not even aware that they were suffering from high BP because most of the time there are no obvious symptoms, which is why it is called a ‘silent killer’. Over the years, it has become a serious health problem in India that leads to 1.1 million deaths annually in the country. It is estimated to account for 10.8% of all deaths and 4.6% of all disability adjusted life years (DALYs).

According to the Global Burden of Disease data collated by a Washington-based Institute for Health Metrics and Evaluation, hypertension was also the fourth-leading risk factor for death and disability and responsible for over 1.6 million deaths in India in 2016.

The capital has been witnessing an unprecedented increase in the number of people suffering from hypertension. According to data collected by NGO Praja Foundation, there were 3,67,833 cases of hypertension in 2017-18 in Delhi, whereas in 2016-17, there were 3,59,039 cases. The data indicated that the number of cases was increasing every year.

Out of the 90,517 institutional deaths in 2016, the highest number of deaths occurred from hypertension at 6,835, which was almost a 76% increase from 2015. The data was collected in a series of RTIs filed between April 2014 and March 2018. The cases were reported from Delhi government hospitals, MCD hospitals and dispensaries.

Another worrying trend is that hypertension, that was earlier thought to afflict mostly those in their 50s and 60s, is increasingly affecting people in the younger age groups — as young as 15 years of age. Jasmeet Bhati, a 35-year-old homemaker, says that she got to know about her high blood pressure six years back. “I never thought I would have to handle high BP at such an early age. I do not even smoke or drink, neither am I overweight,” she says.

Long-term hypertension increases the risk for coronary artery disease, stroke, heart failure, atrial fibrillation, eye blood vessel damage, peripheral vascular disease, sexual dysfunction, chronic kidney disease and dementia. Jayant, a 46-year-old accountant who is a resident of Shalimar Bagh (west Delhi), is suffering from Coronary Heart Disease (CHD) and will have to undergo angioplasty soon.

“I have had high blood pressure since the age of 35. That, along with my obesity and habit of smoking, has landed me in this dreadful situation. I would advise people to lead a healthy lifestyle and to avoid smoking and drinking,” he says, adding, “I am saying this now because I have gone through such an ordeal and I cannot change things for myself. The least I can do is ask people to opt for a lifestyle that might keep such diseases at bay. Also, people should not take high BP lightly. It increases the risk of such diseases to a great magnitude, which is why it is important to keep it under check.”

Hypertension is responsible for 24% of all coronary heart disease (CHD) deaths in India, as suggested by reports. CHD has become an epidemic in India and its growing number of cases can be explained by the alarming rise in the coronary risk factors that include hypertension.

According to a study done by All India Institute of Medical Sciences (AIIMS), one out of two people in urban areas and one out of three in rural areas are aware of the fact that they are suffering from high BP. Multiple factors like stress, lack of sleep, unhealthy food habits and excessive consumption of alcohol and tobacco are pushing young people towards this disease.

One in five young adults in India has high blood pressure, according to research presented at the 70th Annual Conference of the Cardiological Society of India (CSI). Author of the study Dr Kartik Gupta, a physician at AIIMS, says, “High blood pressure hits Indians at a younger age than western populations, and first heart attacks and strokes occur a decade earlier on average. India’s screening programme typically starts at 30, which is too late.

We need to screen and promote healthy lifestyles early to avoid the crisis India is heading for.”

The level of self-reported risk factors was: smoking 7.5%, tobacco chewing 6.6%, diabetes mellitus 2.1%, and high cholesterol 2.2%. Research by CSI has revealed that the risk factor that showed the strongest connection to hypertension was diabetes, which was associated with a doubled risk of developing high BP. According to the Praja Foundation report, diabetes is also on the rise in Delhi there were 3,62,471 cases of diabetes in 2017-18.

Dr Gupta adds, “National data shows that 5–10% of Indians have diabetes, 25–30% chew or smoke tobacco, and 20–30% have high cholesterol. Indians hardly exercise and their diet is traditionally high in salt. Consumption of vegetables and fruits is low and western junk food and soft drinks have become increasingly popular.”

“It is true that the country is being plagued by cases of hypertension and its associated risk factors. Nowadays, young people are suffering from high blood pressure, which points to its profundity. We should start screening for hypertension at around 18 to 19 years of age. Early detection can enable us to deal with it efficiently. Children need to be educated about being physically active, keeping weight under control, eating healthy, cutting down on salt intake and animal fat, and abstaining from consuming tobacco. Better awareness can protect many against developing high blood pressure, diabetes and high cholesterol,” says Dr AK Shadra, a cardiologist who runs his private clinic.

There are usually no symptoms of high BP. Very high BP can cause headaches, blurred vision, nosebleeds, difficulty breathing, chest pain, irregular heartbeat, blood in the urine, confusion, or pounding in the chest, neck or ears. An important component of hypertension management is cardiovascular risk reduction. Controlling risk factors by reduction of cholesterol and diabetes management can further reduce cardiovascular events in patients with hypertension.

“The scenario is such that one in three Indian adults suffers from high blood pressure. High BP can lead to stroke and several heart diseases, which have become the leading causes of death in India. Sedentary lifestyle with little or no physical activity aggravates the problem. During winters, people are at a risk of increased blood pressure, so I urge people to eat healthy, exercise regularly and to monitor their BP,” adds Dr Shadra.

Even though hypertension has for long been one of the major risk factors for cardiovascular diseases and premature deaths globally, its prevalence is increasing in both rural and urban areas. In line with the WHO’s Global Action Plan for the prevention and control of non-communicable diseases (NCD) 2013-2020, India aims to reduce the number of global premature deaths from NCD by 25% by 2050. Can we attain this goal?