Control of Hypertension in the Population. Strategies in Affluent and Developing Countries

Abstract

Control of hypertension in population. Strategies in affluent and developing countries. The control of hypertension encompasses primary prevention, early detection and adequate treatment of high blood pressure. Primary prevention involves action at the population level to reduce obesity, alcohol and salt consumption, and to increase physical activity. The management of hypertension involves diagnostic work-up, assessment of overall cardiovascular disease risk, non-pharmacological and pharmacological treatment. The majority of community control programmes emphasized detection and treatment, rather than primary prevention. There are limitations to pharmacological treatment of hypertension, as shown by various studies, where a significant proportion of hypertensives have not been controlled by the treatment applied. In addition, the blood pressure-cardiovascular risk relationship is continuous and progressive and, even within the conventionally defined "normotensive" range, complications occur with escape control. Developing countries will encounter the problem of prohibitive costs of care and drug treatment for hypertension. Therefore greater emphasis must be put on primary prevention in population control of hypertension.

Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries

“…The present study demonstrates the similarity of this effect in two contrasted countries differing by economic and genetic backgrounds and suggests that the developing countries could implement programmes -with all the necessary local adaptations -that have been successfully tested in developed countries. The observed steady and age-independent linear association between BP and adiposity, which is weak at individual level, favors the population approaches attempting to shift the whole distribution of BP in a more favorable direction by improving the population adiposity profile as measured by anthropometric parameters (BMI, WC, WHR) The present study supports the recommendations of WHO 37 for developing countries to put emphasis on primary prevention community programs promoting physical activity and healthy dietary habits, including the reduction of alcohol drinking and salt intake which are probably involved in the increase of BP with the advance of age. Such programs should target particularly women for whom the expected effect of weight loss on BP appears to be greater than in men.…”

Subjective and Objective Evaluations of Health Among Middle-Aged and Older Veterans with Hypertension

“…Hypertensive patients are often faced with recommendations for lifestyle modifications that intersect diet, exercise, and medication adherence. Despite the morbidity and mortality benefits of controlling hypertension (Collins et al, 1990;Lever & Ramsay, 1995), rates of blood-pressure control range from 6% to 50% (Banegas, Rodriguez-Artalejo, de la Cruz Troca, Guallar-Castillon, & del Rey Calero, 1998;Berlowitz et al, 1998;Burt et al, 1995;Chamontin et al, 1998;Chockalingam & Fodor, 1998;Faulhaber & Luft, 1998;Gyarfas, 1996). The finding that poor health realists experience more medication barriers and are engaged in less exercise may indicate that this group is having problems with adherence and lifestyle modification related to their hypertension.…”

Anthropometric correlates of blood pressure in normotensive Pakistani subjects

“…Decrease in adiposity is one of the most effective preventive measures not only in decreasing the overall cardiovascular risk but also the blood pressure [2,3]. WHO has recommended increase in physical activity and modification of dietary habits as preventive measures to control the high and increasing incidence of cardiovascular diseases in developing countries [4]. South Asians emigrants including the Pakistanis have high prevalence and incidence of cardiovascular diseases International Journal of Cardiology 124 (2008) 259 -262 www.elsevier.com/locate/ijcard in general and metabolic syndrome in particular [5].…”