Thursday, June 24, 2021

Hypertension for Adults, Teens and Kids: An alarming pandemic among Filipinos


Dr. Don Robespierre C. Reyes hosted the 4th Presyon edition webinar organized by the Philippine Heart Association with Corrbridge as sponsor

I recently found out I am hypertensive stage 2, meaning I am at high risk for coronary heart disease, which can lead to a heart attack or stroke. I will need to have my blood pressure checked regularly and follow a strict regimen that will likely include dietary changes, exercise, and lifestyle changes.

I never even thought I had it because I wasn’t even aware of its symptoms. I knew I had diabetes mellitus type 2, but I didn’t know it could also lead to hypertension. Had it not been for my desire to get vaccinated against COVID-19, I wouldn’t have visited my cardiologist. And thus, I’ve found out I was hypertensive and I was given maintenance medicines to keep my blood pressure down.  I was given meds that have the powerful combination of amlodiphine + losartan in one tablet. 

That’s why I was glad when I had been invited along with other bloggers to listen, learn and attend the recent Presyon 4 Webinar organized by the Philippine Heart Association [PHA]. The webinar proved to be very informative especially with resource speakers led by Dr. Jorge A. Sison, past president of the PHA, had discussed the prevalence of hypertension in the country. He also emphasized the importance of awareness, treatment, compliance, and BP control rates. Dr. Sison mentioned that most of the time, we Filipinos would take things for granted, hence, we’d find out about our heart’s condition with 58% end-organ damage. What we often overlook is that stroke is highly related to uncontrolled hypertension, microvasculopathy, risk factors, and poor compliance. According to Dr. Sison, hypertension-related stroke was the most common cause of mortality among the hospital-based population [READ: Uncontrolled BP and poor compliance]

It was alarming to note that amongst the adult population above 18 years old, there were 1,399 males and 1,398 females surveyed. While pediatric population [those from 12-18 years old] has 329 males and 312 females suffering from hypertension. Among the hypertensives, about 25% answered that they have their blood pressure checked only at the comforts of their own homes. Thus, the prevalence of hypertension in the Philippines among adults is 37% [M:52% F: 48%] where 19% are very much aware of their condition and 18% are unaware. The prevalence of hypertension among adolescents is 5% [M: 68% F: 32%] And sadly, none is receiving any treatment. Among adult hypertensives, the treatment rate is 67%, compliance is 87% and BP control rate is 36%. The most common drug used in the country is ARB. And 78% of hypertensives are on monotherapy with the highest compliance among beta-blocker users. Adult hypertensives have higher BMI, waist circumference, and central obesity rate. End organ surveillance showed abnormal ECG in 57%, abnormal ABI in 36%, and microalbuminuria in 11.5% in adult hypertensives. 

Meanwhile, Dr. Roberta Marie Cawed-Mende also reported that 18% are unaware hypertensives. [I was once part of that number. Good thing, I went to see my cardiologist]. Prevalence of hypertension in adolescents is 5%. 33% hypertensive patients are not on antihypertensive medications, 61% on medications are uncontrolled and 13% are non-compliant with their medications.

Current NCD Situation in the PH:

NCDs [cardiovascular diseases, cancers, chronic respiratory diseases, diabetes] still the leading killer. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from NCDs. Prevention, screening, early diagnosis and treatment of NCDs, as well as palliative care, are key components of the response to NCDs. 

PRIMARY CARE is the optimal channel for the health system response to NCDs:

Intervention before risk factor includes promotion of physical activity, population based anti-smoking campaigns and promotion of healthy diet. For control risk factor, smoke cessation interventions and weight control. And for secondary prevention, we need screening for PAP’s smear [for possible cervical cancer], colonoscopy for possible colon cancer and risk screening for cardio-vascular diseases, clinical breast exam [for possible breast cancer].

For tertiary prevention, we can control the disease or minimize the disability if we control blood glucose for diabetic patients, BP control or providing maintenance drugs for hypertension.

Dr. Beverly Lorraine Ho from the Department of Health [DOH] also updated us with what the government is doing for our health system in the country today. The DOH has provided an integrated approach to NCDs by addressing the common behavioral risk factors. DOH also has given access to medicine programs, communication packages on NCDs, and smoking cessation training for regional offices. Aside from those, there are the Universal Health Care Law, Revived Sin Tax Law, and Issuances ad interventions amidst COVID-19 on continuous non-communicable disease and behavioral risk-related services. 

Hypertension and The Youth

Dr. Orlando Bugarin, outgoing PHA president also shared that the prevalence of hypertension globally is increasing with 3.5% of children having hypertension and 2.2%-3.5% children have elevated blood pressure. Higher rates of hypertension are seen among children and adolescents who are overweight and obese. 

Dr. Leus, another PHA past president and pediatric cardiologist said there are two types of hypertension:

Primary hypertension- a diagnosis of exclusion when all other causes of hypertension have been ruled out. This is common among overweight/obese adolescents.

Secondary Hypertension- Hypertension due to underlying medical condition. This is the more common cause of hypertension in children. This is the more severe and symptomatic hypertension.

Blood pressure in children is recommended to be done annually starting at age 3 but every healthcare visit for children with certain risk factors for early hypertension.

In a nutshell, Cardiovascular disease [CVD] is the biggest pandemic that Filipinos face and not COVID. At least two pandemics and both need to be contained. 17.5 million people die per year from CVD including heart attacks and strokes. Hypertension is a strong driver of CVD. Among the many risk factors for heart disease are the following; High blood pressure, diabetes mellitus, obesity/overweight, high cholesterol, and physical inactivity.

The complications of uncontrolled hypertension are catastrophic: Stroke, heart failure, sexual dysfunction, vision loss, heart attack and chronic kidney disease or kidney failure.

What most people don’t know is that heart diseases and hypertension are killing most Filipinos. In fact, based on recent findings, the top ten leading causes of death in the Philippines are the following: Ischaemic heart diseases, neoplasms, cerebrovascular disease, pneumonia, diabetes mellitus, hypertensive diseases, chronic lower respiratory infections, respiratory tuberculosis, other heart diseases, and genitourinary. 

1 billion people are at risk for CVD! The global statistics on hypertension has 1.5 billion adults will be hypertensives worldwide by the year 2025. 

What should we do?

Lifestyle modification should be initiated for those with hypertension:

DASH [Dietary Approach to Stop Hypertension] Diet

Weight loss intervention especially in those obese and overweight

Reduction in salt intake

Avoidance of alcohol and tobacco smoke

Check the nutritional labels of the food we eat.

Regular blood pressure check.

Visit a cardiologist regularly.

Take regular maintenance medications

If pharmacologic treatment is warranted, based on limited studies in children as to efficacy, safety and cost, recommended initial drugs include ACE inhibitor, ARB [Losartan, valsartan], or Calcium channel blocker [Amlodiphine]. 

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