Dr. C.V. Alert, MB BS, DM, FCCFP.
Family Physician.
Hypertension epidemiology in the Caribbean.
- The Caribbean has the highest prevalence of hypertension in the Americas, ranging from 21% to over 38% among adults.
- Countries such as Dominica (50%), Jamaica (48%), and Haiti (48%) report some of the highest global rates.
- Prevalence is approximately 21% in Barbados and Trinidad & Tobago, and 35–38% in St. Kitts, the British Virgin Islands, and Grenada.
- Hypertension is a leading cause of stroke and ischemic heart disease, with risk amplified by high salt intake, poor diet, and limited awareness/control.
- In elderly populations, prevalence may reach 75%.
- This high prevalence of hypertension is leading to massive heath bills that few individuals and no Caribbean Ministry of Finance can adequately budget for. “It breaking we budgets”.
Diagnosis and Control.
- Approximately 37% of hypertensive individuals remain undiagnosed.
- Among those diagnosed, only 18–19% achieve blood pressure control in countries such as Jamaica and Dominica.
- Hypertension is the most prevalent and modifiable risk factor for many cardiovascular diseases, including:
- Coronary artery disease
- Heart failure
- Atrial fibrillation
- Stroke
- Dementia
- Chronic kidney disease
- All-cause mortality
These are the main causes of suffering and death, often prematurely, in most Caribbean countries.
Treatment challenges in the Caribbean Context:
- Hypertension is often asymptomatic until complications arise,
- Public health systems lack universal annual blood pressure checks and structured follow-up. I was invited to present a paper on the topic “How to reduce these numerous uncontrolled hypertensives”, at the CCFPs tri-annual conference in Jamaica in 2021. I started off by saying that we need to improve our public health screening efforts, and we need to improve our treatment strategies once hypertension was detected”. So this is a problem that requires input from both our public health and family medicine practitioners, in a collaborative effort.
- Parallel public and private health systems interact minimally in the Caribbean, limiting population-wide coverage, and collaboration is not widely practiced between the two systems.
Diagnostic Methods.
The new hypertension guidelines emphasize accurate diagnosis using:
- Office blood pressure measurement
- Home blood pressure monitoring (HBPMs)
- Ambulatory blood pressure monitoring (ABPMs)
- ABPMs are often inaccessible (unaffordable) in the Caribbean.
HBPMs are gradually being adopted, at least in Barbados, and show closer correlation with cardiovascular morbidity and mortality than office readings. Family physicians must actively promote the use of HMBPs, as part of the effort to improve awareness.
Evidence-Based Updates (2025).
- Reflects nearly a decade of new data.
- Reinforces tighter control to prevent heart failure, stroke, and cognitive decline.
- Focus has shifted from isolated BP readings to overall cardiovascular risk assessment.
Risk Stratification Protocols, which allow for overall cardiovascular risk assessment.
Two major tools guide aggressive management:
1. Cardiovascular Risk Calculators
- Interventions are based not only on BP levels but also on combined risk factors:
- Blood glucose status
- Lipid profile
- BMI/obesity
- Prior cardiovascular events
CARDIOCAL, developed by PAHO, is a cardiovascular risk calculator tailored for Latin America and the Caribbean, as part of the HEARTS initiative. HEARTS is a WHO-led initiative aimed at strengthening primary health care systems to improve the prevention and control of cardiovascular diseases and their risk factors. Unfortunately, to date, there has been slow adoption of cardiovascular risk calculators by physicians practicing in the Caribbean.
2. KDIGO Heat Map.
- Stratifies risk in patients with chronic kidney disease (CKD).
- Cross-references eGFR and albuminuria to classify risk of progression, cardiovascular events, and mortality.
- Enables precise definition of cardiovascular risk and guides intervention intensity.
Either of these tools, if used serially, can help decisions on whether clinical interventions are actually working, i.e. the patient’s risk for MACE, a Major Adverse Cardiovascular Event, is being lowered, or need further ‘tweaking’.
Failure to adopt these protocols and tools contributes significantly to poor hypertension control and the poor patient outcomes in the Caribbean. Without systemic changes in screening, follow-up, and risk-based management, morbidity and mortality from hypertension will continue to dominate regional health statistics. We need better public awareness, and we need better control.
There are no shortage of speeches by out Health Officials about the damage the NCDs are doing to our communities and our economies, but these speeches rarely offer solutions. NATO applies here – No Action, Talk Only. While Health Officials see this as a Public Health issue, and Public Health needs to chart a new direction, there are some practical solutions that family physicians can adopt and put into action, the improve the care in individual patients.
While Family physicians can’t correct many of the deficiencies in local health care that eventually lead to our (unacceptable) morbidity and mortality statistics, there are readily available tools that, if adopted, can improve the health of many Caribbean persons. The new risk stratification tools allow the shift from relying on blood pressure readings only, and guide overall management towards lowering cardiovascular (NCD) morbidity and mortality.