Hypertension Risk factors are as prevalent in Rural as in urban population-Khawar Kazmi


 Stroke is six time more in rural areas where medicine use is very poor

Hypertension Risk factors are as prevalent in
Rural as in urban population-Khawar Kazmi

We need to establish Hypertension Clinics all over the country
where economically priced Amlodipine and Diuretics
should be available to manage high blood pressure

KARACHI: Hypertension risk factors are as prevalent in rural areas as in cities while stroke is six times more in rural areas as compared to urban population. Not only that, the use of drugs to treatment hypertension is also very poor in the rural areas. This was stated by Prof. Khawar Kazmi, Head of the Dept.of Cardiology at Aga Khan University Hospital while speaking at a meeting organized by Pakistan Hypertension League in collaboration with OBS Pakistan to celebrate the World Hypertension Day here on May 6th 2017. The meeting was chaired by Prof.Azhar M.A.Faruqui while others speakers included Prof. M. Ishaq, Prof. Abu Noeem Faruqui, Prof. A.Rasheed Khan and Prof. Nawaz Lashari. The session was moderated by Prof. A.Rasheed Khan Coordinator of PHL.

Giving further details of a study they are conducting looking at  how the Non-Communicable diseases evolves and what is the outcome, Prof. Khawar Kazmi said that hypertension in rural areas is mostly under diagnosed and untreated. Many of the patients cannot afford expensive anti-hypertensive drugs. The first major symptom they see is in the shape of stroke and renal failure. What we need to manage hypertension to prevent complications is to establish a chain of Hypertension Clinics all over the country at every healthcare facility. That is what has been done by countries in South America who are facing a similar situation. Then it should be ensured that economically priced amlodipine and diuretics are easily available and compliance with drug therapy should be ensured. All anti-hypertensive drugs are effective and they all lower blood pressure. Our objective should be to first reduce the high blood pressure and prevent complications.  Once that is achieved, then one can talk about various classes of antihypertensive drugs available and which could be used in which situation. He again reiterated that first lower the blood pressure and then think which drug is better than other. Low cost generic amlodipine and diuretics can reduce the complications and stroke significantly. Once these generics are used in great quantity they will also become financially viable for the drug manufacturers, he added.

Earlier Prof.M.Ishaq  General Secretary PHL in his presentation talking about epidemiology said that 20% of all adult population is suffering from high blood pressure and this is the most common disease affecting the people all over the world. It is important to avoid complications which is only possible if high blood pressure is identified early and treatment is initiated immediately besides ensuring compliance with drug therapy. Non Communicable Diseases are now very common in the society. The disease is increasing in South Asia where the resources are limited. It is essential that doctors should be sensitized and they must check blood pressure of every patient coming to them with whatever complaints. PHL has prepared Guidelines on Management of Hypertension and we are also starting a ten module Certificate Course in Hypertension at our offices for the Family Physicians on hypertension management. He emphasized the importance of accurate blood pressure measurement, proper  assessment of the patient, he opined, is an art. Apart from creating awareness about high blood pressure,  life style modifications, we need to educate the people to reduce salt, sugar intake and also reduce the use of Fats.

Pakistan Hypertension League in collaboration with OBS Pakistan organized a meeting in Karachi
to celebrate the World Hypertension Day on May 7th 2017. Group Photograph taken  at the occasion
shows  From (L to R) are Mr. Sajjad Ahmed,  Mr. Adeel Anjum, Dr. Col (R) Muhammad Iftikhar Nuri,
 Prof. Khawar Kazmi, Prof. A. Rasheed Khan, Prof. M. Ishaq,  Prof. Azhar M. A. Faruqui,
Prof. Nawaz Lashari,  Prof. Abu Noeem Faruqui and Mr. Nayyer Anwar.

Prof. Abu Noeem Faruqui speaking at the occasion said that it was essential to know the cause of high blood pressure. We need to manage hypertension, atherosclerosis, stroke, myocardial infarction and foot problems. Symptoms become visible with complication and that is too late. We have six groups of anti-hypertensive drugs starting from diuretics and we have now JNC 7 and 8 Guidelines as well. In diabetics with hypertension ACE Inhibitors should be used first which will not only bring down blood pressure but will also control renal problems. ACEIs will also stop worsening of micro proteinuria and reverse it. He also talked about retinopathy in diabetics which needs immediate management. Always see if there are new vascularization in the retina in diabetics. Target blood pressure of diabetics is 130/80 while those with 140/90 or DBP of 80-90 are pre hypertension stage. Life style modifications will take care of pre-hypertension stage.

Prof. Nawaz Lashari from Civil Hospital Karachi discussed interventions in hypertension. He pointed out that if medical treatment fails to control high blood pressure, there are various interventions which can be opted. These treatment modalities are quite safe and effective. However it is essential to give a fair trial to drug therapy using three antihypertensive in combination in optimal dose along with diuretics. Sometimes drug compliance is an issue or the dose of drugs prescribed is not optimal. He also referred to Reno vascular diseases, obstructive sleep apnea and said that about 10% of patients can have significant renal stenosis. It is important to select the patients for these interventions which should be done only if the medical therapy fails, he added.

During the discussion it was pointed out that for treating hypertension during pregnancy, Methyldopa is the ideal drug which is safe and effective. Diuretics can also be used in small dose. Beta blockers can also be used in small dose if the patients are being monitored properly. Hypertension has lot of adverse effects on fetus and placenta. Methyldopa should be used in proper dose. It is also important to find out how to improve compliance of patients with drug therapy. The patients should be educated about the likely adverse effects like cough associated with ACEIs and if patient are not informed, they will stop taking drugs as soon as they have cough.

Summing up the discussion Prof. Azhar Faruqui in his concluding remarks said that it was strange that even after one hundred twenty years when blood pressure was measured for the first time, we are still debating as to what is the ideal blood pressure. The medical profession has failed to take any final decision on this issue. It is difficult to decide what the normal blood pressure is. We must know how to treat, when to treat and what makes the patients stop treatment needs to be looked into. An ideal blood pressure is said to be 120/80. Some say it should remain less than 140/90 but there are others who feel that in elderly patients even 150/90 is fine. However, what is important is to prevent stroke and heart failure. Health failure with diabetes is a significant group. In diabetics 130/80 should be the target and it must be achieved otherwise it will increase mortality. For them 130/80 is the best and good target and try to achieve that while we must also keep the new evidence in mind, he added.

Prof. A. Rasheed and Prof. Ishaq thanked OBS Pakistan for organizing this seminar to promote the aims and objectives of Pakistan Hypertension League. In the morning OBS Pakistan, Prof. Ishaq stated had organized an awareness campaign at KMDC. Later Mr. Nayyar Anwar along with Prof. Azhar Farooqui presented mementoes to the panelists. Earlier Mr. Adeel Anjum welcomed the distinguished speakers, chairpersons and the participants on behalf of OBS Pakistan.

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