Rising trend

Poor and the young are new victims of hypertension

Published: Saturday 30 April 2011

Rising trend

imageOne of the biggest killers of modern times, hypertension has silently rooted itself in rural India, where 71 per cent of the country’s population resides.

Till recently, hypertension was considered an urban malaise. A compilation of countrywide data collected over the past few decades showed 25 per cent of urban population as hypertensive. Only 10 per cent rural people had high blood pressure. This data was compiled by the Centre for Chronic Disease Control (CCDC), a Delhi-based non-profit, in 2009 as part of a World Bank study on non-communicable diseases.

But a recent study conducted by the Indian Council of Medical Research (ICMR) in seven states reveals hypertension has blunted the urban-rural divide. In fact, in some states the disease is more prevalent in rural areas than urban.

  Pre-hypertension is most prevalent among the youth in rural Mizoram  
The first phase of the three-phase study examined hypertension cases in Maharashtra, Andhra Pradesh, Mizoram, Madhya Pradesh, Kerala, Tamil Nadu and Uttarakhand. Its results, released in December 2010, show rural Maharashtra is the worst hit. Andhra Pradesh and Mizoram follow. In other states, incidence of hypertension in rural areas has nearly reached the levels of urban regions.

The percentage of pre-hypertension cases in rural areas has also increased over the years. In pre-hypertension, a person’s blood pressure is elevated above normal but not to the level considered to be hypertension. In rural Maharashtra, more than 40 per cent youngsters (15-19 years) suffer from pre-hypertension. It is seen most among the rural youth of Mizoram.

World checks BP
A study published in medical journal The Lancet shows the incidence of high blood pressure has increased globally. The survey of 199 countries also shows that while cases of blood pressure are rising in developing countries, richer nations are bucking the trend (see table). The study was published in the February issue of the journal.

“The findings are an opportunity to implement policies that lead to healthier diets, especially lower salt intake, at all levels of economic strata. These can also help find ways to improve detection and control through primary healthcare system,” says Majid Ezzati of the department of epidemiology and biostatistics at the Imperial College in London, who led the study.
What’s worse, this chronic medical condition, that once afflicted people in their sixties, has now struck the youth. Maharashtra again is the worst sufferer. ICMR found that people as young as 15 years had hypertension.

Incidentally, states that show high levels of hypertension are relatively rich. Maharashtra, for instance, has per capita income of Rs 1,6479. This is second highest in the country, according to data collected in 2003-2004 by the directorate of Economics & Statistics. Andhra Pradesh, too, has a high per capita income of Rs 11,333.

According to the CCDC study, hypertension cases would rise from 118.2 million in 2000 to 213.5 million in 2025. The ICMR data suggests that most of this increase is likely to be in rural areas.

ICMR’s is the first major study conducted to identify the risk factors of non-communicable diseases in India. The study took into account age group, gender and residence (urban or rural). In each state, 5,000 households were contacted and asked to fill a questionnaire.

The Union Ministry of Health and Family Welfare wants to use this study to device policies to control chronic diseases that emerge from hypertension. However, the ministry will not get any more data because the study has been suspended after the World Bank, which was funding the Integrated Disease Surveillance Project, stopped financial aide owing to delay in the study’s execution.

Varying BP limits add to confusion
Ever since hypertension was identified a risk factor for non-communicable diseases, the blood pressure level considered harmful has been changed frequently. Studies conducted on the subject have been highly localised, small-scale and on people of different ages. As a result, they cannot be compared to show a trend.

imageThe US’ National Institutes of Health (NIH), one of the world’s foremost medical research centres, has been releasing regular reports of its Joint National Committee (JNC) on prevention, detection, evaluation and treatment of high blood pressure since 1976. Its seventh report, released in 2003, defined prehypertension for the first time. It considers people with systolic blood pressure of 120-139 mmHg and diastolic pressure of 80- 89 mmHg pre-hypertensive.

Beyond the pressure of 115/75 mmHg, the risk of heart ailments doubles with every rise of 20/10 mmHg, states the report. The eighth JNC report is likely to be released soon. In India, a 1954 study—based on a higher cut-off of 160/95 mmHg— showed just 4 per cent industrial workers in Kanpur were hypertensive.

Using the same limit, a Delhi study conducted in 1984 found that only 3 per cent of the population had hypertension. But another study conducted in Delhi between 1984 and 1987 said almost 11 per cent men and 12 per cent women in urban pockets had high blood pressure. The figures for men and women in rural areas were 4 and 3 per cent respectively. The cut-off used was 160/90 mmHg.

Studies conducted in Jaipur in 1994, 2001 and 2003 show rise in cases of hypertension. These used 140/90 mmHg as the cut-off and showed an increase in hypertension cases from 30 per cent in 1994 to 36 per cent to 51 per cent in men and from 34 per cent to 38 per cent to 51 per cent among women. These mixed signals make assessment of a trend difficult.


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