A recent issue of the journal Lancet was dedicated to hypertension, now the biggest single contributor to the global burden of disease. Hypertension directly or indirectly causes 9.4 million deaths a year worldwide. The most startling finding is the marked recent increase in incidence in developing countries, presumably due to unhealthy dietary and lifestyle changes. This issue includes a comprehensive review, Hypertension in Developing Countries, which emphasizes that nearly ¾ of people with hypertension live in developing countries, and that the incidence of hypertension related cardiovascular disease and stroke has also skyrocketed. These countries have a low awareness of hypertension and few opportunities for diagnosis and management.
For those of us used to a quick fix infectious disease model of tropical medicine, this development requires a change in our thinking. Proper management of chronic hypertension requires:
· Accurate diagnosis
· Careful selection of the most effective drug
· Proper management of contributing factors such as obesity, exercise and possible diabetes
· Above all, careful monitoring over an extended period of timAll of these in turn require a local health system that is well trained in long term management, available on a continuing basis, and is accessible and affordable.
The Centers for Disease Control and the Pan American Health Organization are launching a Global Standardized Hypertension Treatment Process, with initial trials in Latin America and the Caribbean. The process aims to develop a core set of medications and a structured approach to management that can eventually be applied globally.
This is a promising step forward, but this or any other process cannot succeed without local health systems that are trained, prepared and funded to undertake this major responsibility. As health volunteers, we need to advocate for and support efforts to improve local health systems, and to educate local populations about the risk of hypertension to their health and the importance of proper management.
Submitted by Roger Boe MD