World Hypertension Day 2023.

Dr. C.V. Alert, MB BS, DM. Family Physician.
Dr. D. C. Scantlebury, MB BS , DM, FACC, FACP, FSCAI. Consultant Interventional Cardiologist.
Heart and Stroke Foundation of Barbados.

May 17^th 2023 is World Hypertension Day. Hypertension is one of the most prevalent chronic illnesses in Barbados, and the Heart and Stroke Foundation of Barbados (HSFB) joins Medical Associations around the world in recognizing the importance of prevention, early detection, appropriate treatment and rehabilitation of hypertension complications, as vitally important components of managing this important condition.

In the last three decades there have been at least two major studies in Barbados that looked at blood pressure in adults aged 25 years and older. The first of these studies, published in 1995, was the ICSHIB Study, the International Collaborative Study of Hypertension in Blacks. Parts of West Africa; three Caribbean countries (Jamaica, St. Lucia, and Barbados); Manchester in the U.K.; and Chicago in the USA, where presumably blacks were of similar genetic stock, were the sites from which volunteers were recruited. In 1995, the international “cut-off” value for diagnosing hypertension was 160/90 mmhg, and in Barbados 21 percent of the people studied had hypertension. Fifty-eight percent of persons known to have hypertension did not have their blood pressure controlled.

The second study, published 20 years later in 2015, was the Barbados Health of the Nation Study. The international “cut-off” value for diagnosing hypertension had been lowered to 140/90 mmhg, as higher blood pressure values were associated with excess illness and death. The prevalence of hypertension had doubled, to 42 percent. Fifty-eight percent of persons known to have hypertension did not have their blood pressure controlled.

So, over this twenty year period, the prevalence of hypertension, based on the changed international “cut-off” points, had actually doubled. What did not change was the percentage of persons who did not have their blood pressure controlled. Our health services, even with free polyclinic care and access to free medications for treating hypertension, still could not affect control of blood pressure in a majority of persons. Our medical personnel have some of the expertise, but lack many of the resources, to perform these important functions.

When hypertension is not controlled, complications can set in. Many people do not realise that they have high blood pressure until one (or more) of these complications develop, meaning hypertension has caused significant damage to one (or more) of the body’s internal organs. Major complications of hypertension include heart attacks and strokes, as well as conditions such as dementia, blindness, heart failure, kidney problems and circulatory problems, called peripheral arterial disease (PAD). These conditions are quite common in Barbados, even though some individuals affected by them may not be aware of this. Our hospital services have been expanded in the last two decades to include special units for heart and stroke patients. These units are always filled to the brim, for on average in Barbados we have a heart attack a day and three strokes every two days. Our medical services are overwhelmed by patients with hypertension and its complications. We all need to do our part to reduce this load on our health services.

But what can “You” do?

1. A diet high in sodium (salt) is associated with high blood pressure. As a nation, we need to eat less salt and less salty foods. Unfortunately, many foods which seem to be integral to our culture and lifestyles are high salt foods, such as salt-fish, pig-tails, and souce. Other foods, such as corned beef, luncheon meat, hamburgers and hot-dogs, salt bread, salty snacks like chips are also popular. Many people add salt to their meals at the meal table. “You” need to cut down, if not cut-out, foods that have a lot of salt, and try not to add extra salt to your meals. Doing this can reduce your risk of developing hypertension and its complications.
2. A plant-based diet, where the emphasis is on fruits and vegetables, is also a ‘low-salt’ diet as vegetables and fruit have no salt. In addition, fruits and vegetables are high in potassium, which counters the effect of sodium. Eating more fruits and vegetables helps lower the blood pressure, and is integral in maintaining a healthy body weight.
3. Exercise regularly. There is an immediate effect of exercise on blood pressure. During exercise, the blood pressure increases to supply the muscles, but soon after finishing the exercise, the blood pressure drops. The more you exercise, the greater is the blood pressure lowering over the long term. There are many other health benefits of exercise, but the benefits include ‘making you sweat’, and sweat pulls some salt out of the body. Regular exercise is also vitally important for achieving and maintaining a healthy weight, as hypertension and obesity are closely related.
4. Drink more water. It is no secret that the days are getting hotter, a situation that seems likely to continue. Drinking more water, apart from keeping you cool and well hydrated, also stimulates the kidneys to produce more urine, and this can be another way that the body can get rid of some excess salt.
5. While, as a country, we are in the early days of legislating nutrition labels on foodstuff, hopefully to be soon followed by educational programs aimed at the ‘person in the supermarket and kitchen’; individually we can develop the good habits associated with being careful with what we put into our bodies. So looking at food labels, in particular the amount of sodium in each serving is a good habit to adopt.
6. All adults should have their blood pressure measured, as part of at least an annual ‘check-up’. If you have been diagnosed with hypertension, and/or high blood pressure runs in your family, in addition to the annual medical check consider doing your blood pressures at home, called self-monitoring of blood pressure (SMBPs). In fact, international guidelines for treating high blood pressure are putting increased emphasis on readings generated by SMBP in directing decisions on blood pressure management.
7. Your doctor should use this annual check-up to look for other illnesses such as obesity, diabetes, dyslipidemias (‘high cholesterols’), and chronic kidney disease. Like hypertension, these conditions are often silent in the early phases, but they accelerate the development of the complications of hypertension, and they make these complications more aggressive. If detected early, treatment can be started early to slow down or even prevent these complications.
8. If you have been diagnosed with hypertension, please follow the advice or your health care provider. You cannot rely on how you feel. High blood pressure can ‘eat you out from the inside’ [like termites do to your home] while on the outside you can feel fine. Most people with hypertension in the early days have no symptoms, and many persons only have symptoms when their internal organs are damaged. We may not be able to undo damage to these internal organs at this point, but we may be able to prevent (or at least slow down) the rate at which damage is occurring, to improve the quality of life, and to slow the progression to death.

Hypertension, like all of the non-communicable diseases, is having a major negative impact on the health of individuals, on our workforce and those of retirement age, and on the national economy. We can all do our part in working towards a healthier Barbados. The Heart and Stroke Foundation of Barbados is committed to not letting high blood pressure give us ‘more pressure’.