LHypertension (HTN) is the most common cardiovascular risk factor It is produced by the increase, sustained over time, in the force exerted by the blood on the walls of the arteries.
It is a disease that affects 1 in 3 adults and generally has no symptoms. And, if left undiagnosed and untreated, it frequently causes serious complications such as heart attack, stroke, or the need for dialysis for kidney damage and other ailments.
In Argentina, as is the case throughout the world, HTN is on the rise. Its prevalence in our country increased considerably between 2009 and 2016, an increase reflected in the epidemiological studies RENATA I and RENATA II. The latter recorded that 36.3% of the adult population in our country has high blood pressure levels. However, 38.8% of hypertensive patients are unaware of their condition. And among those who know it, only a minority is well controlled. The prevalence of HT has a special characteristic: it increases as age increases. It can be 12.2% in those under 35 years of age and reach 77.4% in those over 65 years of age. These figures are very similar to those observed in the rest of the world.
“The most worrying thing about all these rising numbers is that only a minority is well controlled. There is poor control of the value of hypertension in pre-pandemic times, so the problem has surely grown and the figures will increase in a future study. The first step in treating HA is knowing it. Know your blood pressure level”, assured the doctor Carolina Chacón cardiologist, a clinical researcher who is part of the scientific group of experts of Clinical Studies Latin America (ECLA).
It is estimated that hypertension (HT) currently affects between 25% and 30% of the world’s population. And data from the Pan American Health Organization (PAHO) indicate that in Latin America and the Caribbean, HT between 20% and 40% of adults suffer from this disease, which represents about 250 million people. Every year about 1.6 million Latin Americans die from these diseases. Still, the control rates are unacceptably low.
“A recent study published in The Lancet reflects how high blood pressure has doubled worldwide in 30 years in people aged 30 to 79 years. This research analyzed more than 1000 studies that included more than millions of patients in the world. And what it indicates is that in 30 years the total number of people in the world with HTN has doubled. It is also true that life expectancy also increased, but the research left more interesting and worrying numbers to analyze, “said Chacón, who is vice president of the Committee for Cardiovascular Prevention and Epidemiology of the Argentine Federation of Cardiology and works at the Instituto Cardiovascular de Rosary beads.
According to the scientific study, HTA grew from 331 million women and 317 million men in 1990 to 626 million women and 652 million men in 2019, despite a stable age-standardized global prevalence. This new international research reveals two big negative pieces of information. First, in the last three decades, the number of adults living with hypertension around the world has doubled, now reaching 1,278 million people affected. The second indicates that more than half of them have not yet received any medical treatment. According to this report from The Lancet, lowering blood pressure can reduce the number of strokes by 40%, heart attacks by 25%, and heart failure by 50%.
“According to the work, the prevalence of HT is 32% in women and 34% in men, according to data recorded in 2019, that is, before the pandemic. In percentage, it is quite similar to what happened 30 years ago. But in terms of concrete numbers, it grew a lot, twice. An interesting fact that emerges is that the disease lowered its prevalence in high-income countries. And on the contrary, it rose a lot in low-income countries, with the exception of Peru. In general, Eastern Europe, Latin, and Central America, and Africa have a higher prevalence of HTN and worse health controls. In addition, it must be taken into account that 50% of the population does not know that they are hypertensive ”, said the specialist.
And he added: “ In high-income countries, there is a prevalence of 25%. Of these cases, 80% are treated and 60% of these patients have optimal control of HA. In recent years they have managed to lower the number of cases because they promote health policies and access to treatment, with a high cultural and educational component, which generates empathy to undergo care and treatment. But in low-income countries, there is a prevalence of HT that ranges from 45% to 60%. Of these, only 40% are treated. And of the total of hypertensive patients, only a third is with controlled pressure, that is to say, that in addition to being treated, they comply with the taking of medication and consumption of healthy foods, low sodium consumption, in addition to doing frequent exercise and not smoking or drink alcohol”.
“In Argentina, the prevalence is 46% according to the latest National Survey of Risk Factors 4, made in 2018 and published in 2019. Which shows that we have high numbers of HTN in the country. It was also recorded that 61% of the population is overweight. And half of them suffer from obesity (3 out of 10 Argentines). It is a very worrying reality, which has probably grown in the last two years, since the COVID-19 pandemic promoted the consumption of ultra-processed foods, increased salt intake, led to less exercise and people became more sedentary when doing virtual work and study from home. And not to mention the increase in idle activities such as spending more time on social networks, virtual games and Zoom meetings”, remarked Chacón, who highlighted that the World Health Organization (WHO) maintains that you have to eat 5 varied servings of fruits and vegetables and also perform at least 150 minutes of weekly exercise, divided into 30 minutes daily.
For the expert, one of the jobs that should be promoted the most is communication and education about the risk factors that increase arterial hypertension. “ The highest prevalence occurs in sectors with a lower educational level, such as Argentina, where the ENFR 4 registered that only 5% of those surveyed consumed fruits and vegetables in the recommended amount. The other 95% do not. Therefore, applying educational policies from childhood generates healthy habits that will impact the future of the person. It’s hard to change eating and physical activity habits when you’re older. That is why the campaigns have to be a reality to improve the educational level of the population ”, he added.
Returning to the Lancet study, the expert revealed possible good news: since 2000, thanks to the implementation of WHO strategies for 2025, the curve of new cases of HTN in Latin America has been flattened. Its growth was not as exponential as in the 1990s. But the downside is that 82% of people with HT live in low-income countries. And there we return to the importance of food education and healthy habits such as doing regular physical exercise, not smoking or drinking alcohol.
“Worldwide, only 23% of women with HT are controlled and only 18% of men. According to studies carried out in Rosario, the HTA program that began in 2014 with itinerant blood pressure measurement campaigns, we found that 70% were hypertensive. We registered 9000 people and 50 of them already knew they were hypertensive. Thus, 7 out of 10 people did not have controlled pressure or at optimal levels. This study, with high levels of hypertension in the population, has the bias: they were people who came to health posts. Many of them already knew they were sick. It was not a study like a census, where you go to look for hypertension”, explained Chacón, who recalled the importance of checking yourself periodically.
Hypertension is defined by the detection of averages of systolic (“maximum”) and/or diastolic (minimum) blood pressure above the limits established as normal for the records obtained in the office. This limit is 140 mmHg for systolic and 90 mmHg for diastolic. Systolic or maximum blood pressure is the force exerted by the blood on the arteries when the heart contracts. Diastolic blood pressure reflects the pressure in the arteries when the heart is at rest, between heartbeats. “If a person has 135mmHg do not wait for it to reach 140 mmHg to tell you that you are hypertensive. It is in yellow light. It is a warning that you have to change your habits and consult your doctor so as not to suffer from a serious picture of arterial hypertension”, concluded the specialist.