HAMI- a good initiative by conscious
cardiologists to create awareness
and manage hypertension

PESHAWAR: HAMI is a new Platform created by some conscious healthcare professionals, cardiologists in collaboration with High noon Pharmaceuticals to create awareness and manage high blood pressure. At present almost 40% of our population is suffering from hypertension and measures taken so far are highly unsatisfactory. The prevalence of hypertension is increasing and it has assumed an epidemic form. Most of the healthcare professionals, professional specialty organizations like Pakistan Cardiac Society and Pakistan Hypertension League are fond of holding their conferences and meetings at Five Star Hotels and none of them has ever seriously tried to go into the community and work there.

Pakistan Hypertension League as well as Pakistan Cardiac Society has also come up with Guidelines for detection and management of hypertension which have also been revised and updated recently. However, neither a vast majority of the Family Physicians with whom the patients come into contact first; is aware of it nor are these guidelines being implemented. In this background it is heartening to note that some conscious physicians have taken this step to form HAMI which stands for Hypertension Awareness and Managing Initiative. This campaign is being spearheaded by Prof. Khawar Kazmi along with Prof. Feroze Memon, Prof. Saulat Siddique and few other noted cardiologists. Speaking at World Heart Day organized by Pakistan Cardiac Society at Karachi sometime ago, Prof. Khawar Kazmi had also suggested the establishment of dedicated Hypertension Clinics at hospitals and making arrangements to provide economically priced calcium channel blocker like Amlodipine and Thiazide diuretics or other combination of drugs. Fortunately these are the very names who have always tried to convince their colleagues of upholding professional ethics at these conferences but somehow it has all fallen on deaf ears so far. Hence, one sincerely hopes that if the objective of this Platform is utilized effectively in letter and spirit, it is going to make a real difference and once they are successful to move into the community as planned and take some important steps, it will achieve the desired results and its contribution and accomplishments may be greater than the efforts put in by various professional specialty organizations during the last many years.

HAMI organized a panel discussion on Hypertension during the PHL Conference at
Peshawar last month. Picture taken on the occasion shows from (L to R) Dr. Amar
Hameed, Prof. Feroze Memon, Prof. Khawar Kazmi and Prof. Saulat
Siddique participating in the discussion.

HAMI held its formal meeting during the 23rd annual conference of Pakistan Hypertension League on March 7th 2020 at Peshawar. It was chaired by Prof. Khawar Kazmi. The other speakers in the meeting included Prof. Saulat Siddique and Prof. Feroze Memon besides Dr. Amar Hameed from Aga Khan University. Prof. Feroze Memon in his introductory remarks stated that the overall prevalence of Hypertension is about 18% in people over the age of fifteen years as per last National Health Survey. The prevalence of hypertension in female after the age of fifty years according to a study done in 2011 is 27%. A more recent study by Prof. Basit and his group has reported the prevalence of Hypertension of 46%; the prevalence is very high in urban areas but low in rural areas. By adopting proper measures, we can prevent this growing epidemic as it affects all organs of the body. We must prevent hypertension and send this message to everyone to assist in managing high blood pressure.

Prof. Saulat Siddique emphasized the importance of creating awareness in the community. Step care approach, he opined, was not practical. Number of patients is on ARBs, ACEIs, Thiazide diuretics and Aspirin. People over the age of fifty years can be advised to take low dose Aspirin regularly. Each and every healthcare professional must be advised to check the blood pressure of the patients. Tests cost but we can make a beginning.

Prof. Khawar Kazmi suggested the use of social media and Television Channels. It was also suggested that we can use Mosques and Religious leaders to create awareness about high blood pressure. Lowest cost effective drugs should be made available and pharmaceutical companies can be approached to produce cost effective anti-hypertensive drugs so that poor patients can buy those drugs. Non affordability is one of the most important reasons for failure to compliance with drug therapy. One has to be careful about the side effects and these patients must be regularly followed up. Prof. Khawar Kazmi emphasized upon the use of non-invasive screening of the population. We usually under estimate the risk of tests and cost. If the cost of medication is less than 5% of their monthly salary, only then the patients will continue to take the drugs, he remarked.

Some eminent cardiologist photographed during session on management of hypertension
organized by HAMI – an entity established by Highnoon, during the PHL conference
held at Peshawar recently.

Dr. Amar Hameed shared the details of the COBRA Guidelines, the project which their group has just completed in three countries Pakistan, Sri Lanka and Bangladesh. Findings of this study have been published in New England Journal of Medicine recently. In this community initiative, drugs were provided to the patients. Doctors were trained. Community Health Workers were educated and trained. He was of the view that we can reduce blood pressure through multidisciplinary approach. All work as a team and patients get economical drugs. These patients were followed up and Echo was also done and the quality of the data that we have generated in this study is very good. A decrease of just 2.5mmHg in systolic blood pressure resulted in 7-10% reduction in mortality. In this project we trained the physicians, community health workers, utilized the existing government health infrastructure. Simple evidence based guidelines were sent to them. Information was available at Hypertension Center in the hospital. Drugs were also available though not free. In Pakistan we had selected three sites for this study and Ambulatory Blood Pressure Monitoring was also used. We are using media for this, he added.

Prof. Khawar Kazmi stated that we are starting a dedicated Hypertension Clinic at NICVD. We have already established quite a few Chest Pain Units in the city of Karachi. However, it is extremely important that low cost effective drugs are made available to these patients. Prof. Shahbaz Kureshi said that he and Prof. Shaukat Malik have gone to the Mosques, Schools and colleges in Islamabad, given lectures and also measured high blood pressure to create awareness about this disease. These lectures were very well received and we got encouraging response from the religious leaders. It was also suggested that if a Polypill containing ARBs, ACEIs, Statins and Aspirin was made available, it can do wonders. This combination is already being used in some countries. One of the participants suggested that NADRA should be approached and whenever some one goes to get his/her National Identity Card, their blood pressure should be measured and this will provide us some highly useful data. Another suggestion was that blood pressure measurement facilities should be made available at all the Pharmacy shops, Malls, Shopping Centers as well as Community Centers . Media it was emphasized should be involved and we should aim at multipronged strategy. Moving into the community and working there will pay rich dividends. Yet another suggestion put forward was to include School Health Service. Lady Health Visitors, all Community Health Workers should be involved and they should be trained and asked to take blood pressure measurement. Primary healthcare facilities of the governments all over the country can also be utilized. Prof. Khawar Kazmi thanked the participants for some very useful suggestions and hoped that it will help them in making their future plans to move forward in the fight against control of hypertension.

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