RAG-SACA-2: EPIDEMIOLOGY OF HYPERTENSION IN SOUTH ASIA

Abstract

Hypertension is the one of major risk factor contributes to the burden of heart disease, stroke, kidney failure, disability and premature death. According to 2019 WHO fact sheet, an estimated 1.13 billion people worldwide have hypertension while only 21% of people have it under control. Further, more than one million deaths are related to hypertension. It is projected that 1.56 billion adults (29.2%) have hypertension globally by 2025 and 75% of them will be Asians and Africans.Hypertension is the most prevalent risk factor of stroke among Asians and cardiovascular complications associated with hypertension is steeper in Asians compared to west. Asia is a diverse region with differences in prevalence, awareness, treatment and control of hypertension. The trend of prevalence of hypertension has been vividly increased over the past two decades in South East Asian countries and numerous factors contribute to the current hypertension burden including modernization, urbanization, lifestyle changes and socioeconomic status. Hypertension prevalence in south East Asia is 25% and is slightly higher than the global prevalence (22%). According to the data from May-Measurement-Month 2018, the prevalence of hypertension in South Asia was 29.3% and only 46% of them aware about their hypertension while 43% was on medication. However, only 23.9% of them had controlled blood pressure either with medication, life style modification or both. East Asia had the lowest blood pressure average (117.0/75.4 mm Hg). In contrast, South Asia had the highest average (124.6/78.1 mm Hg). According to a recent meta-analysis, the prevalence of hypertension was 17.9% in Bangladesh, 20.9% in Sri Lanka,23.9% in Bhutan,25% in Pakistan,31.4% in India,31.5% in Maldives and 33.8% in Nepal. As per WHO data in 2020 among South Asians, Pakistan had highest hypertensive related death whereas Sri Lanka had the lowest (nearly 20 vs 4 per 100,000). Overweight and obesity in women and higher waist circumference in men are significantly associated with uncontrolled hypertension. Excess salt intake (average daily intake is higher than 12 g) associated with elevated blood pressure is also considered as a specific characteristic of hypertension in Asia. A vital issue in Asia is not just the high prevalence of hypertension, especially in some countries, but also the low level of awareness and treatment rates in many regions. Future research are necessary to implement strategies for prevention and control of hypertension, especially in low-income populations and to precisely assess the prevalence and financial burden of hypertension in the region.