Tuesday, April 9, 2013

World Health Day 2013




                      
                                  Hypertension a silent killer in India
World Health Day – 7 April 2013
 Theme for 2013 world health day is hypertension                                                   
   Dr.M.A.Aleem MD, DM, (Neuro)
  Professor of Neurology,
  KAPV Government Medical College & MGM Government Hospital,
  ABC Hospital Trichy, Tamilnadu, India.                E- Mail: drmaaleem@hotmail.com     
               
Every year, the World Health Organization selects a priority area of global public health concern as the theme for World Health Day.
The theme for World Health Day 2013 is controlling high blood pressure, a condition which affect more than one in three adults worldwide. For millions of people, high blood pressure will lead to fatal heart attacks, debilitation strokes, and chronic heart and kidney disease.
As the world’s population ages and grows, unhealthy behaviors – an unbalance diet, a lack of physical activity, and smoking, harmful use of alcohol – together with stressful lifestyles, all increase the chances of developing high blood pressure. All regions of the world are affected.
High blood pressure is both preventable and treatable. Increasing public awareness is key, as is access to early detection. Countries need systems and services in place to support healthy lifestyles. Access to medicines of good quality, which are effective and inexpensive, is also vital, particularly at primary care level.
This year’s campaign provides an opportunity to focus attention on the prevention and control of high blood pressure, as a means of reducing the number of people affected, both now and in the future, by cardiovascular disease.
Cardiovascular diseases are the number one cause of death globally. They account for approximately 17 million deaths in the world each year.
Complications of high blood pressure also called Hypertension or raised blood pressure account for more than nine million of these deaths, including about half of all deaths from heart disease and stroke. More than one in three adults worldwide has high blood pressure with the proportion going up to one in two for people aged 50 and above. The number of people with high blood pressure rose from 600 million in 1980 to 1 billion in 2008.
Behind the statistics is a silent killer that can affect anyone; people often have no symptoms, and many are not even aware of high blood pressure and associated health risks. The result is that many go undiagnosed.
Many who are diagnosed do not have access to treatment or their conditions are poorly controlled. Self-care – meaning actions or behaviors each person can take in his or her daily life – also plays an important role.
There is social cost to this problem too. In some countries, money spent on cardiovascular diseases alone can be one fifth of the total health expenditure. Yet million of people forgo seeking care for high blood pressure in the early stages because they cannot afford it. The results are devastating for both families and health systems: early death, disability, personal and household disruption, loss of income, a diminished workforce, and medical care expenditures take their toll on families, communities and national health budgets.
Early detection and treatment are key, along with public policies and primary health – care services that educate and support people to prevent them from developing high blood pressure to manage it effectively
 High blood pressure (also known as raised blood pressure or hypertension) can lead to heart attack, stroke and other serious health problem. It affects more than one in three adults and leads to more than nine million deaths worldwide every year. High blood pressure can also cause kidney failure, blindness, rupture of blood vessels and brain impairment.
Many people do not know that they have high blood pressure because it does not always cause symptoms. Even though it is easily diagnosed and treated, many people do not have access to basic health services, particularly in low – and middle-income countries.
High blood pressure is both preventable and treatable.                                                                                                 Controlling high blood pressure, together with other risk factors, is the main way to prevent heart attack and stroke.
The risk of developing high blood pressure can be minimized by: cutting down on salt; eating a balanced diet; avoiding harmful use of alcohol; getting regular exercise; and avoiding tobacco use.         
For many people, lifestyle changes are sufficient to control blood pressure. For other, medication is required. Inexpensive medication exists, which is effective when taken as prescribed.               
It is essential that detection and control of high blood pressure (measurement, health advice and treatment) are coupled with simultaneous reduction of other risk factors that cause heart attacks and strokes such as diabetes and tobacco use. They should be core elements of primary health care in all countries and integral to efforts to reduce the growing burden of no communicable diseases           

Facts and figures
·         More than one in three adults worldwide have high blood pressure, with the proportion going up to one in two for people aged 50 and above. 
·         The number of people with Hypertension rose from 600 million in 1980 to 1 billion in 2008.
·         Complications of high blood pressure account for more than 9 million deaths worldwide every year. This includes 51% of deaths due to strokes and 45% of death due to coronary heart disease.
·         The prevalence of high blood pressure is highest in the African Region at 46%. The lowest prevalence is in the Americas Region at 35%. Globally, overall prevalence of high blood pressure in adults aged 25 and older was around 40%in 2008.
·         Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths.
·         Treating systolic blood pressure and diastolic blood pressure until they are less than 140/90 mmHg is associated with a reduction in cardiovascular complications.
·         To reduce premature mortality from NCDs by 25 per cent by 2020 – by reducing intake of alcohol and physical inactivity by 10 per cent each and intake of salt/sodium by 30 per cent. This will reduce high blood pressure incidence by 25 per cent. Use of tobacco is targeted to be brought down by 30 per cent in addition to improving medicines, technology and counseling.   
IN INDIA
·         Hypertension is a major contributor to avoidable death and disease in India, too with an increasing impact in the country and the number is expected to cross the 214 million mark in 2030.
·          Hypertension is a major risk factor for cardio – vascular diseases that killed 2.7 million people in 2004 and will result in the death of over 4 million people by 2030
·         It is estimated that 20 – 40 per cent population in urban areas and 12 – 17 per cent in rural areas have Hypertension.
·         A WHO estimate in 2008 suggested 33 per cent men and 32 per cent women older than 25 years had Hypertension in India.
·         An Integrated Disease Surveillance Prevalence Survey of 2007 – 2008 indicates a very high percentage of Indians are in a pre – Hypertension stage.
·         Mizoram had 58.5 per cent people in per - Hypertension stage though the actual population suffering from high blood pressure was only 19 per cent. This was followed by Uttarakhand with 48.8 per cent, Kerala (48.1 per cent) and Maharashtra (46.2 per cent). Madhya Pradesh, Tamil Nadu and Andhra Pradesh are among the other States that have over 40 per cent of the population in the pre – Hypertension category.      
·         Hypertension has serious economic implications also; it is a leading cause of hospitalization and out – patient visits.
·         A month’s treatment with just one anti – Hypertension medication cost 1.8 days wages and becomes unaffordable if more than one drug is prescribed or more than one drug is prescribed or more than one drug is prescribed or more than one person has Hypertension in the family.
·         As per the World Health Organization (WHO), high blood pressure affects every third person about the age of 18. The proportion increases with age, from 1 in 10 people in their 20s and 30s to 5 in 10 people in their 50s.
·         Public health experts estimated that the number of patients in India with high blood pressure is likely to rise from about 140 million in 2008 to nearly 215 million my 2030 along with increase in the risk of complications arising out of high blood pressure such as heart attacks, strokes, including kidney disease and other serious illnesses.
·         High blood pressure as of today remains inadequately controlled in India as large number of cases go undetected.
·         The incidence of high blood pressure ranges from 20 to 39 per cent in urban areas and 12 to 17 per cent in rural areas.
·         The problem is further compounded as high blood pressure is a silent killer as it can remain undetected and manifest years later as a serious heart problem.
·         However, high blood pressure is both preventable and treatable. For many people lifestyle changes such cutting down on salt; eating a balanced diet; avoiding harmful use of alcohol; getting regular exercise; and avoiding tobacco use are sufficient to control blood pressure. For other, medication is required which is effective when taken as prescribed.
·         ‘Merely sticking to medicine and controlling dietary and lifestyle regime can easily avert any complications arising out of high blood pressure.
·         It is important to get BP checked on a regular basis and avoids self – medication.
·         Cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020.
·          Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India
In TAMIL NADU                                                                       
·         Tamil Nadu had started a pilot project in Sivaganga and Viirudhunagar districts during 2007 – 2010 to screen and treat people for Hypertension during which about 11,31,000 people were screened for Hypertension in 98 health facilities. The pilot project has been scaled up in 16 districts by the Tamil Nadu Health Systems Project (TNHSP).’This year we have been implementing the   phase I of the programmed to screen and treat people with hypertension in 16 districts. Preparatory activities, including training are underway in the remaining 16 phase II districts. By March – April 2013, the remaining 16 II districts will also be implementing the project, thus covering the entire state will be under the project. Our Tamilnadu chief minister J.Jayalalitha is keen to prevent non communicable diseases in Tamilnadu. She is strengthening the health infrastructure in Tamilnadu to tackle all for better health.                    
    

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