Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework

The use of Rose Angina Questionnaire and 12 lead Electrocardiogram (ECG) in the Identification of potential Ischemic Heart Changes among a group of Hypertensive Patients in Sri Lanka

Introduction: Ischemic heart diseases (IHDs)are a leading cause of mortalities in Sri Lanka. Among a variety of risk factors, hypertension is a leading cause for IHDs; however, unequal distribution of proper diagnostic facilities complicates the early diagnosis of ischemic changes among adults in Sri Lanka. Therefore this study aimed at studying the possibility of using two basic diagnostic tools, including Rose angina questionnaire (RAQ) and 12 lead electrocardiogram (EGC), to estimate the potential ischemic heart changes among the hypertensive patients in a selected Sri Lankan adult population.Methods: A consecutive sample of 150 hypertensive individuals was recruited, and data were gathered through an interviewer-administered questionnaire, RAQ, blood pressure measurement, and ST-segment analysis of standard 12 –lead ECG recordings.Results and Discussion: The majority of the participants (n = 93, 62%) were females. The mean age was 61.5 ± 10.33 years, and their average systolic and diastolic blood pressures were 146 ± 23.27Hgmm and 85 ± 12.08 Hgmm. The association of ST-segment deviations that denote IHDs and the presence of stage I or II hypertension (n = 52, 42%) was statistically significant (p <0.05, df = 1). Based on positive responses to both RAQ and ST-segment deviations, the proportion of individuals with potential Ischemic Heart changes among the hypertensive individuals was 23% (34/150). Except these, 37/150 (25%) of hypertensive individuals, exhibited potential ischemic heart changes only in 12 lead ECG, but the responses to RAQ were negative. On the other hand, responses RAQ was positive among 32/150 (21%) individuals, though none of them exhibited any significant ST-segment changes in their 12 lead ECGs.Conclusion: Based on the utility of RAQ and 12 lead ECG, about a quarter of hypertensive individuals could be detected as having potential ischemic heart changes. Therefore it is suggested that RAQ can be incorporated along with 12 lead ECG into the routine clinical assessment to identify the risk of IHDs among Sri Lankan hypertensive individuals

Lifestyle factors associated with obesity in a cohort of males in the central province of Sri Lanka: a cross-sectional descriptive study

Abstract Background Obesity has become a global epidemic. The prevalence of obesity has also increased in the South Asian region in the last decade. However, dietary and lifestyle factors associated with obesity in Sri Lankan adults are unclear. The objective of the current study was to investigate the association of dietary and lifestyle patterns with overweight and obesity in a cohort of males from the Central Province of Sri Lanka. Methods A total of 2469 males aged between 16 and 72 years ( x ¯ = 31 $$\overline{x}=31$$ ) were included in the study. The sample comprised individuals who presented for a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. The Body Mass Index (BMI) cutoff values for Asians were used to categorize the participants into four groups as underweight, normal weight, overweight or obese. The data on dietary and lifestyle patterns such as level of physical activity, smoking, alcohol consumption, sleeping hours and other socio demographic data were obtained using validated self-administered questionnaires. Multinomial logistic regression model was fitted to assess the associations of individual lifestyle patterns with overweight and obesity. Results The mean BMI of the study group was 22.7 kg m−2 and prevalence rates of overweight and obesity were 31.8 and 12.3%, respectively. Mean waist circumference of the participants was 78.6 cm with 17.1% of them being centrally obese. After adjusting for potential confounders, weight status was associated with older age (P < 0.0001), ethnicity (P = 0.0033) and higher income (P = 0.0006). While higher physical activity showed a trend for being associated with lower odds of being obese (odds ratio: 0.898 – confidence interval: 0.744–1.084), alcohol intake, consumption of fruits, level of education, sleeping hours, smoking, consumption of fish, meat, dairy, sweets or fried snacks were not significantly associated with the weight status. Conclusion The high prevalence rates of overweight and obesity in working-age males is a threatening sign for Sri Lanka. Since the prevalence rate is higher in certain ethnic groups and higher-income groups, targeted interventions for these groups may be necessary

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension.

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools