One of the leading causes of premature deaths in men and women across the world is the “silent killer” hypertension. It is so prevalent that 1 in 4 men and 1 in 5 women have hypertension. The World Health Organization estimates that it is the cause of 7.5 million deaths annually, which is about 12.8% of the total of all deaths. Defined as high blood pressure, hypertension is when the systolic blood pressure reading is greater than 140 mmHg and the diastolic blood pressure reading is greater 90 than mmHg.
Hypertension can cause serious damage to the heart which could fatally lead to heart attack or heart failure. It can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke. Alarmingly, there is an extensive list of factors which cause hypertension including but not limited to: smoking, being overweight or obese, lack of physical activity, too much sodium in the diet, stress, older age, genetics, and family history of high blood pressure.
More than 1.13 billion people globally have hypertension
This is only the number of people who have been diagnosed; millions more could be unknowingly living with hypertension given that most people are unaware of the problem as it may have no warning signs or symptoms. In the South-East Asian region, hypertension affects one in three adults and the trend is ever increasing. The prevalence of hypertension among all adults and elderly people (60 years and above) in Bangladesh is 25% and 40% respectively.
Given that more than two-thirds of those with hypertension reside in low- and middle-income countries, a new study endeavoured to examine the inequalities in the prevalence of undiagnosed hypertension among Bangladeshi adults using data from Bangladesh Demographic Health Survey 2011. The research was conducted with 8,835 adult participants of both sexes aged 35 years and above as this group is at higher risk of hypertension. 1,685 cases of hypertension was found among the study participants, of which 978 (59.9% of all hypertensive individuals in the study) were found to be undiagnosed.
Undiagnosed hypertension among adults is a growing concern in Bangladesh. Photo: Sumon Yusuf/icddr,b
The prevalence of undiagnosed hypertension was higher among male patients than female patients (66.9% vs 55.5%) and among those in the no institutional education group (63.9%), in comparison to those who had higher education (49.4%). It was also higher among the people from the poorest (69.7%) and poorer (69.6%) quintiles compared to people who belonged to the richest (50.8%) quintile. Surprisingly, those who are underweight are more likely to have undiagnosed hypertension (65.5%) due to the false belief that hypertension strikes only those who are overweight or obese.
Mr Sayem Ahmed, assistant scientist at icddr,b and the principal author hypothesise that the reasoning behind so many cases of undiagnosed hypertension could be
“due to lack of awareness, inaccessibility to screening services and the patient’s unwillingness to go to doctors for a regular check-up until any or related health complication arises”.
Furthermore, it is expensive for those who are financially disadvantaged to undergo a screening test for hypertension as it entails costs which they cannot spare. Thus, Mr Ahmed concludes that
“the level of education and wealth are two of the most important socioeconomic factors for undiagnosed hypertension”.
One of the enduring challenges with chronic, non-communicable diseases is the long-term financial burden of treatment and care. It costs a hypertensive patient an average of BDT 4,500 (USD 54) per annum for drugs, supplies, and human resources at healthcare facilities at primary and secondary levels. Most of these expenses are likely to be paid out-of-pocket, adding more financial burden to marginalised groups that are already facing monetary hardships. Targeted policies need to be developed and implemented which raises awareness on the individual’s importance to regularly undergo blood pressure check-ups while at the institutional level, policies must strengthen primary healthcare facilities. Screening should be available for all patients regardless of whether they are hypertensive or non-hypertensive adults with medicine available and affordable for those who require it to thwart this preventable disease.