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Castillo, Rafael

doi: 10.1097/01.hjh.0000499881.98439.59

Similar to the trend worldwide, hypertension (HTN) is also the single most attributable cause for mortality in South-East Asia (SEA). But while in developed regions, the prevalence of HTN appears to be stabilizing or decreasing, the rates in SEA continue to rise. Around a third of the adult population in SEA have elevated blood pressure (BP) with nearly 1.5 million deaths (9.4% of total deaths) attributable to HTN annually.

In several countries in SEA, awareness level of HTN is less than 50% but in the more affluent countries in the region, awareness ranges from 56% to 70%. Of those aware that they have hypertension, about half are on treatment, following the global rule of halves in HTN. Control rates to BP levels below 140/90[REPLACEMENT CHARACTER]mmHg remains dismally low.

HTN is also a common comorbid condition with type 2 diabetes mellitus (T2DM) in the region, with HTN coexisting in 40%-60% of individuals with T2DM, and vice-versa. These dual problem likely accounts for the increased deaths due to cardiovascular disease (CVD), which remains the leading cause of mortality.

At least seven countries in the region have standard national guidelines for the management of hypertension, with some of these countries initiating efforts at reducing salt intake at the population level. These efforts need to be scaled up and adopted by the other countries in SEA.

Considered an urgent public health problem, barriers to effective prevention and control remain a major challenge in the region. These barriers include cultural norms and practices that promote unhealthy behaviors and misconceptions about HTN, the lack of an enabling environment for healthy lifestyle practices, increased tobacco use, disparities in healthcare with inadequate access for early detection and treatment especially primary healthcare facilities, high out-of-pocket cost of treatment, and generally poor adherence to treatment.

Majority of the countries in SEA have already strengthened their public education campaigns and surveillance systems to increase awareness to HTN and other cardiovascular risk factors, and improve management and control. However, prevention and control of hypertension is complex, and has to be approached via a multi-sectoral collaboration.

Professional cardiovascular organizations, together with the rest of civil society can help convince their respective policy-makers and governments to increase allocation of resources for HTN and CVD control programs, particularly primary healthcare approaches. A strong-willed health leadership is imperative to effectively execute population-based integrated approaches that target the risk factors of HTN, especially increased salt in processed foods and the other mentioned barriers to prevention and control.

If these programs and interventions are sustained, this will definitely help achieve the ’25-25’ vision or goal of global cardiovascular organizations including the International Society of Hypertension, that is, a 25% reduction in the prevalence of HTN and its related complications by the year 2025 in SEA and worldwide.

Cardiology-Internal Medicine, Manila Doctors’ Hospital, Adventist University of the Philippines College of Medicine, Philippines


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