Dr. C. V. Alert, MB BS, DM.
Family Physician.
In the old days, sometimes referred to as the good old days, when you heard that someone was very ill,
or heaven forbid had died unexpectedly, one could generally assume that that person had ‘real real
high’ blood pressure, or was a ‘bad’ diabetic. Life, in the days before we ever heard about covid-19 and
monkey pox, or that a lot of our food came from Ukraine, was very different from today.
But the science has evolved, and we now know a lot more about hypertension, as well as the other non-
communicable diseases (ncds). In 1995, an adult was diagnosed as having hypertension if his/her blood
pressure was 160/95 mmhg or higher. Nowadays, this ‘cut-off’ point has been reduced to 130/80 mmhg,
as extensive medical research has shown that pressures much lower than 160/95 mmhg can cause
serious damage, or even death. This also means that many persons can be diagnosed as having
hypertension, and many more people need to be treated, if they will avoid the medical complications of
hypertension, which include dementia, blindness, strokes, heart diseases, chronic kidney disease and
important condition which affects the circulation in the legs, called PAD, peripheral arterial disease.
In the old days, especially depending on one’s political affiliation, there were no gangs or terrorists in
Barbados or the Caribbean. Now, most health care professionals believe that there is a gang of health
terrorists that are driving the ncds pandemic, maiming and killing Caribbean peoples at ever increasing
rates. The main terrorists are diabetes (‘sugar’), hypertension (‘pressure’), obesity and dyslipidemias (a
medical term that includes elevated cholesterol levels). In the old days obesity and cholesterol hardly
got a mention, but they have come to the front lines to terrorize our health. We ignore them at our
peril, and while ongoing research internationally is developing new strategies for dealing with these
conditions, we are unable to afford many of the strategies attached to these cutting edge treatment
options.
These gang members all chip in to destroy us. One does not need to have a ‘real real high’ blood
pressure (alias hypertension), or to be a ‘bad’ diabetic, to go blind, have a massive heart attack, or even
lose a limb. [Remember, in the good old days, Barbados still had the reputation as “The Amputation
Capital of the World”. We don’t hear that so any more not because our rates of amputations have
dropped significantly. They haven’t. We don’t hear that so much anymore because other countries have
caught up with us. We are not alone.]
So now, someone can have ‘a mildly elevated pressure’, a touch of sugar, be a little too heavy and the
blood tests (if done at all) showed that the (bad) cholesterol was a bit high. A little pressure + a little
sugar + a little cholesterol + a few pounds too heavy = Big big trouble, as far as the ncd complications
are concerned. Hypertension, diabetes, obesity and the dyslipidemias are all called ‘silent’ killers, but
when they get together they make a lot of deadly noises.
These gangs are supported by many ‘bad boys’ in our community. Inactivity, a.k.a. laziness, and unhealthy eating, a.k.a. likerishness, give moral and actual support to an unhealthy lifestyle. People eat’ like they born hungry’, flocking in droves to one (or more) of the many fast food outlets we have around the island. Fruits and vegetables, staples on most healthy eating diets, are generally forbidden items, as persons prefer fare that is fried, salty, greasy and very sweet. Cigarettes, alcohol and marijuana are still the items of choice for recreation. But while, as far as personal health is concerned, these bad boys contribute to unhealthy lifestyles, as far as personal choice is concerned, far too many persons directly choose these options. After all, if they get sick, they get free medical consultations at their polyclinics
and/or the Accident and Emergency Department and many free medications for treating the ncds that appear on the national drug formulary. And you know how Caribbean people like the concept ‘free’. And one can also get time off from work, in many cases with pay.
Because the ncds travel in gangs, it is necessary to look out for all of them. It is not safe to conclude that
‘all I have a touch of pressure, I will be all right’, without knowing your status of the other silent ncds.
Seek and ye shall find: all adults, when going in for a ‘check-up’, should make sure that all these ncds
should be checked. [There are new ‘tools’, available to health care professionals, called cardiovascular
risk calculators, which use data like blood sugar, blood pressure, smoker or not, etc, to calculate the
probability of a major cardiovascular complication occurring in the next 5 years (generally), and to
advise on the necessary steps to reduce this risk. Ask your doctor about this at your next full check-up.]
This normally means that one attempts to control as many of them as possible: eat healthy, avoid
smoking and alcohol, exercise regularly, lose weight if necessary, take your medications consistently, go
for your check-ups regularly, and negotiate with your doctor the best lifestyle plan for you.
So who are at risk of these ncds, i.e. who are the most vulnerable to this gang of health terrorists? One
group include those with a family history of one or more of the ncds, or family members who have
unexplained deaths at an early age (generally before 60 years). Another group includes those who vital
organs, like the brain, the eyes, the heart, the kidneys, or the vascular tree (a.k.a the arteries that supply
blood carrying oxygen and nutrients all around the body) have evidence of previous damage, such as a
previous mini-strofe or full stroke, dementia, poor vision, chest pains on walking, kidney disease or poor
circulation. These are signs of early high blood pressure (or other ncd) effects, and if the blood pressure
is not aggressively lowered at that point, continued organ damage and even death can result. This is
why a particular blood pressure reading in one person may not be (so) serious, but may be deadly in
another person. Another group at risk are those who, in addition to a little pressure, also have their
organs weakened by one (or more) of the other major ncds like obesity, diabetes and dyslipidemias.
Persons who decline to get regular exercise, who choose a diet devoid of water, fruits and vegetables,
but instead filled with sweet, salty and greasy items, need to reverse course immediately or schedule an
appointment with an undertaker. Similarly those who continue to smoke, whether the drugs are legal
or illegal, are at risk for heart attacks, strokes, kidney problems or even lower limb amputations. And, as
we approach Crop Over Season, where every year about two dozen of our calypso songs encourage us
to drink alcohol like we trying to ‘buss the alcohol factory’, we should remember one observation from
one calypso from the good old days: “Rum (alcohol) goin kill yuh”.
There has been a lot of change since the good old days; unfortunately many of the changes, of eating
habits and (lack of) physical activity, have contributed to us becoming ‘less healthy’ as time goes on: we
have become more obese and more sedentary. Unfortunately as well, as scientific research gives us
new protocols and new pharmacotherapy for dealing with the ncds, we find ourselves to be less able to
afford many of the new therapies. Our most affordable option is prevention: by adopting appropriate
eating habits, physical activity regimes, avoiding smoking and other dangerous drugs, and starting this as
early as possible in life and continuing until the end – from the womb to the tomb- we can give
ourselves the best chance of staving off the damaging effects of this gang of health terrorists.
There is a role for our Health Officials to step up to bat, but each individual must play his or her part.
What should individuals do?
Prevent hypertension: Control your weight. Avoid the ‘belly-full’ portions at every meal. Avoid (as much
as possible) salt and salty foods, like salt fish, salt meat, pig-tails, corned beef and luncheon meat, to
name a few. A lot of tinned and packaged foods also contain a lot of salt. Drink lots of water. Exercise
regularly: all adults should aim for at least 30 minutes of moderate intensity daily exercise for five or
more days weekly. Getting adequate amounts of sleep is also important. Currently, all families, but
particularly those who already have a family member with one or more of the ncds, are advised to
invest in a high quality blood pressure measuring machine (sphygmomanometer) so that all family
members can develop the good habit of monitoring their blood pressures. An annual visit to the family
physician is strongly recommended, in part to seek out any ‘silent killer’ that may be lurking in the
shadows, and to devise personal targets for weight, blood pressure, blood sugar and cholesterol. With
the family physician’s advice, each individual is encouraged to negotiate a healthy lifestyle plan, and to
proceed to drug therapy as soon as it is needed. If the blood pressure is not prevented, then we must
aggressively attempt to control it, as the consequences of uncontrolled hypertension are both
devastating and deadly, and are very expensive to treat. While the government attempts to offer free
primary care, to date attempting to treat ncd complications requires a level of financial resources that
Caribbean governments are hard pressed to sustain.
Prevention of the ‘gang of ncd terrorists’ is a lot easier, and a lot more likely to succeed, than allowing
these ‘silent killers’ to sneak in and take over your health, your finances and ultimately your life. These
ncd terrorists move like termites: they sneak in quietly into your space, and often by the time you realise
that yhey are there they have already inflicted major damage. Full scale adoption of healthy lifestyle
habits, 24/7/365 (and 366 in leap years) offers your best chance for staving off this gang of terrorists. An
ounce of prevention is better than a pound of cure.