1.5 Million People were screened for hypertension in 89 countries during 2018


 PHL’s 22nd Annual Congress at Lahore
1.5 Million People were screened for
hypertension in 89 countries during 2018
BP of 140/90 should be considered for treatment of
hypertension-Prof. Neil Poulter
High Blood Pressure is the single major risk factor for
morbidity & mortality the world over-Prof.Saulat Siddique

Lahore: About 1.5 Million people were screened for high blood pressure in 89 countries during 2018 and Pakistan contributed twenty five thousand people. By 2025 it is expected that there will be 1.5 Billion patients suffering from hypertension. This was stated by Prof. Neil Poulter former President of International Hypertension League. He was speaking on global perspective of hypertension in the inaugural session of Pakistan Hypertension League’s 22nd annual conference held at Lahore from 21-24 February 2019. He further pointed out that at present only 46.5% of people know that they are suffering from hypertension and out of this 40.6% are being treated. Only 13% of them have achieved the desired blood pressure and remain under control.

These figures show that almost 50% of the remaining population remain untouched. International Society of Hypertension, he said, continues its awareness campaign around the world and it has decided to dedicate the month of May for measurement of blood pressure. Every one above the age of 18 years should get their blood pressure checked. During 2017 we had screened 1.2 million people and in 2018 we increased this figure to 1.5 million. We have so far covered one hundred countries. This whole campaign cost us just one US dollar per person and was the most cost effective strategy. More resources will be made available during 2019. He was of the view that the standard of hypertension needs to be re-defined. Recently American Heart Association has come up with the figures of 130/80 and all such people are being labeled as hypertensives but there is no evidence that we should start treating a systolic blood pressure of 130-139. BP measurement of 140/90 should remain the standard figure for starting treatment for hypertension, he remarked.

Continuing Prof. Neil Poulter said that currently only 13.2% of patients suffering from hypertension remain under control. We need to use more than one drug as monotherapy is inadequate. For treatment we need at least two drugs. We also need to find out what combinations suit the people in South Asia. NICE guidelines recommend the combination of Ace Inhibitors and Calcium Channel Blockers whereas European Society of Hypertension recommends the combinations of ACEIs and CCBs as well as ACEIs and Diuretics. JNC8 also recommends the combination of calcium channel blockers and diuretics for Blacks. At present three combinations are more popular and recommended. These include ACIs plus CCBs, ACEIs plus Diuretics besides Calcium Channel Blockers and Diuretics. We need to find out which combination is more effective and appropriate in Africa, Far East and South East Asia. VALU trial showed that the combination of Calcium Channel Blockers and Diuretic was good. British Heart Study has showed that combination of ACEIs and CCBs is the best therapy. Studies have also showed that ACEIs are superior to ARBs. Meta analysis shows that ACEIs offer significant benefit in mortality as compared to ARBs. However various guidelines say that both are equally effective.

All guidelines Prof. Neil Poulter stated have included ACEIs, CCBs and Diuretics in their recommendations. However, most patients do not take drugs as they cannot afford it. Hence, it is our fault. Some patients may need five drugs. Statins should be given to all patients as it is a good add on and it is more effective than the addition of the fourth drug. Now flexible single pill combinations are available. They reduce side effects, improve cardiovascular disease protection and are also most cost effective. Single pill combinations have many advantages. They are also economical and we need to use the right drug in the right patient. It is important that we know which patient needs which combination of drugs. We need to educate the doctors, community health workers, nurses and the people at large. We also need to educate the government that this strategy is most cost effective.

Prof. Javed Akram Vice Chancellor of University of Health Sciences who was the chief guest in the inaugural session said that hypertension behaves differently in different countries. It is a very deadly disease in blacks. It is much more prevalent in Pakistan and almost 50% of the population suffer from high blood pressure. We need to have local studies and local data. All the studies done so far had very few patients from Asia. The Asian population is different. Pakistan has never been a part of any important multicentre study. We need to focus on local studies and ensure that Pakistan is included in all the future multicenter studies. He also disclosed that we in Pakistan Aspirin Foundation are now planning to conduct a multicenter study which has been named as A4P (Aspirin in Primary Prevention of Cardiovascular diseases in Pakistani Patients). We intend to enroll thousands of patients. Pakistan Society of Internal Medicine has also been founded recently which will be a research oriented society. At the UHS we are moving to patient centered approach, giving too much emphasis to research and generation of local data so that we can come up with local guidelines. UHS, he further stated, will collaborate with PHL and all other medical institutions to promote research culture in the country. We also plan to start PhD in Target Organ Damage. He was of the view that much lower blood pressure was also dangerous for our patients in Pakistan. Medical students also need to be involved in research rather than concentrating on examination all the time. He appreciated the idea of forming a collaborative group of all the professional specialty organizations by Dr. Bilal Mohydin whom he termed as a bulldozer who does things the way he wants and you cannot stop him.

Earlier Prof. Saulat Siddique President of Pakistan Hypertension League in his address said that Ambulatory Blood Pressure Monitoring was started in Lahore by the Chief Guest Prof. Javed Akram. Various studies have showed that at present almost 50% of Pakistan’s population is suffering from hypertension which is an alarming figure. Blood pressure is the single major risk factor for morbidity and mortality the world over. We have to work with multipronged attack to tackle this problem. We can use the Mosque Imams, talk to them and convince them to create awareness about high blood pressure. Let us put emphasis on prevention of known risk factors like weight reduction, control diet, and ensure regular exercise. We can also use social media for the awareness campaign. Everyone in the society need to contribute in this campaign. He laid emphasis on proper diagnosis of hypertension and putting different ideas into practice. Everybody should get his/her blood pressure checked but it does not happen because doctors are too busy.

Electronic BP apparatus, Prof. Saulat Siddique opined is a good idea and all the chemists should be asked to provide this facility of BP measurement. Similarly this facility should also be made available at Airports and Railway Stations. For treatment evidence based combinations should be recommended and they are easily available. We need economically priced drugs which are affordable for the patients. If expensive drugs are prescribed, patients will not take it. He reiterated the need for using cost effective combinations for the management of hypertension. Our objective should be to lower the Blood Pressure with which ever drug is available and which the patient will take, he remarked.

Prof. Khalid Masood Gondal VC KEMU speaking at the occasion said that diabetes and hypertension were common chronic diseases which affect all parts of the body. Hence timely diagnosis and appropriate treatment was important. However, unfortunately most of the patients present to the doctors too late. We need to create more awareness, work on prevention rather than looking at curative aspects of hypertension. He also suggested to start a Certificate Course in Hypertension and hoped that all the three medical universities in Lahore UHS, KEMU and FJMU will join hands for this academic activity.

Prof. Azhar Masood Farooqui founder President of PHL and Prof. Abid Amin Vice President of PHL also briefly addressed the participants. A documentary produced by OBS on behalf of PHL which gave pictorial glimpses of the PHL meetings and activities since its inception was also shown to the participants. Prof. M. Ishaq Secretary PHL remarked that at present all the chapters of PHL are active organizing CME programmes. We have also started a ten module Certificate Course in Hypertension for GPs, Family Physicians. The first batch has successfully completed this course. We are also planning to establish two new chapter of PHL one in Nowshera and the other in Gilgit-Baltistan. He also commended the services of late Dr. Maqbool H.Jafary and Prof. Ashfaq for their contributions to the PHL.

Dr. Bilal Mohydin chief organizer of the conference said that we have tried to involved twenty two professional organizations, institutions in the conference which had the theme of “Reaching Out”. I got full liberty to organize the conference the way I wanted hence I made lot of innovations. We invited all the professional specialty organizations and all of them responded positively. They are participating in the scientific progamme. We have also involved the fourth and final year medical students. When we were students no body taught us hypertension as this topic was just mentioned in Medicine. Still it is not given too much importance despite the fact that hypertension is very prevalent. We need to look at our curriculum and revise it. Even Qarshi University, he stated, was also participating in the conference and this will help us to convey our message to the population at large through different ways.

Organizers of the symposium had introduced many innovations. Apart from involving a large number of professional specialty organizations and institutions as well as medical students in the scientific programme which expanded its scope manifold, they also ensured that no uninvited guests, spouses and children are seen in the conference, area, lunch boxes were arranged for only registered participants and no entry was allowed without registration badges. However, these austerity measures did not help the pharma trade and industry which is always asked to sponsor such meetings as they were charged millions of rupees for stalls and their participation. Industry sponsored lunch time symposia was clearly identified. Despite the fact that it was announced from the very beginning by the organizers that registration for House Officers and Postgraduates for the scientific sessions was free, unfortunately attendance in sessions devoted to Ophthalmology and Women Health was very disappointing the figure remaining within a dozen including the speakers and chairpersons. However the attendance in sessions devoted to Nursing, Obstetrics & Gynaecology, Endocrinology and Aspirin Update was very good. The quality of the presentations was good, audiovisual arrangements were excellent and in every session enough time was given for discussion which must be appreciated.