Uncontrolled blood pressure is one of the main risk factors for cardiovascular diseases (CVDs) such as heart attacks and stroke. They are responsible for one-third of total deaths in India. With more than 200 million people diagnosed with hypertension in India, only 20 million people have it under control. With recent changes in lifestyle patterns, hypertension has become increasingly common in young people, sometimes as young as 10 years old. Lack of awareness is said to be the main cause of widespread hypertension. With this in mind, Citizen consumer and civic Action Group (CAG) organised a multi-stakeholder consultation on hypertension care and control inviting doctors and nutritionists from Tamil Nadu, Karnataka and Telangana; other experts and civil society organisations from across Tamil Nadu. Dr. Rashmi Kundapur, Additional Professor, Community and Family Medicine, AIIMS - Hyderabad, Dr.Vijay Chakravarti - Physician, Cloudnine Hospitals, Dr.Anita Kadagad - Ayurveda Practitioner from Karnataka, Dr.Maheswari - Gynaecologist representing Indian Medical Association (IMA), Dr.S.Anand - Physician from Thiruvarur, Dr.N.Preetha - Assistant Professor, Clinical Nutrition Department from Sri Ramachandra Institute of Higher Education and Research, Chennai and Ms.Ramya - Dietitian and Nutritionist from Karnataka were the panellists.
Ms.Saroja, Executive Director, CAG welcoming the gathering
Ms Saroja, Executive Director, CAG welcomed the gathering and set the context for the meeting. Dr.Om Prakash Bera, Lead Consultant, India State Policy, Global Health Advocacy Incubator, joined the meeting online and highlighted the need for hypertension awareness among citizens. He proposed that the government should have an open dialogue with the common people, CSOs, doctors, etc, because any successful intervention requires a reasonable public understanding of hypertension and the involvement of each and every household.
Dr Rashmi Kundapur - Additional Professor, Community and Family Medicine, AIIMS - Hyderabad chaired the panel discussion. In her introductory remarks, she clarified that hypertension is not a modern disease but something which existed even during our ancestors’ lifetimes as it is a result of the ageing process. She explained that “to control hypertension, we need interventions at 3 levels - medical, policy and community.” Although we have adequate medical care and treatments for hypertension, the political will, community awareness and knowledge were lacking. She introduced the rule of halves in hypertension; “Only half of the total people with hypertension approach the doctor for treatment, out of which only half of them receive the right diagnosis, out of which only half of them receive the right treatment and out of which only half of them continue the treatment. Therefore only ⅛ of people receive appropriate care for hypertension while ⅞ of hypertensive people remain untreated”. She later posed questions to other panellists asking their experiences and challenges while diagnosing and treating patients for hypertension.
Dr. Vijay Chakravarti, renowned physician, Cloudnine Hospitals, Chennai highlighted the problem with data relating to hypertension in India. He said that the current data we have on hypertension vastly underestimates the incidence of the condition and that the actual numbers may easily be 2 or 3 times higher. This could be because not many people come forward to get treated for hypertension as they may not be aware of it. In most cases, hypertension is asymptomatic, especially in young people between the ages of 30 to 35, and only manifests in the last stage as a stroke. He pointed out that another important factor is the lack of patient trust on a doctor, especially a specialist. “Nowadays people directly go to a specialist doctor for even a small medical issue; for instance they go to a neurologist with only a headache as a symptom”, he explained. He explained that the concept of a family doctor has therefore gone; and so has the trust between families and their physician. He believes that patients are more likely to trust a doctor whom they have known for a few years since the doctor is well aware of the patient’s and family’s medical history. “India needs to adopt the practice of general physician or family physician where every patient goes to their general practitioner first for any symptoms and then the general practitioner will guide them to the appropriate specialist if needed”, he suggested. He also strongly advised that while we spend indiscriminately buying new gadgets, every household should have a blood pressure apparatus to ensure regular self-monitoring.
Dr. Maheswari, gynaecologist representing Indian Medical Association (IMA) explained that ignorance is the main problem we need to target in hypertension care and control in India. “Being educated doesn’t necessarily mean that people are aware of hypertension”. She also agreed with Dr.Vijay that we need a family physician system which is likely to instil faith in doctors among people. She mentioned that people take hypertension lightly, claiming occasional deprivation of sleep, stressful periods in office, cheat days in diets, etc. But she emphasised that doctors are seeing many cases of pre-hypertension in young adults. Pre-hypertension can subsequently lead to renal failure, cardiovascular issues and strokes. And this can be primarily attributed to the change in lifestyle patterns including poor sleeping, eating, and working habits, lack of exercise and a sedentary lifestyle. Since people are not aware of the dangers and prevalence of hypertension, they don’t check their blood pressure regularly. Many are hesitant to go to a hospital; neither do they have a blood pressure apparatus at home. “We need to come up with creative ways to engage people to check their blood pressure. We can have a BP monitor available for free check up in public places such as malls, parks, movie theatres, recreational halls, etc”. She warned that hypertension is like a wildfire; the earlier we catch it, the better for the person. If left unchecked, it will continue to spread and affect other parts of the body.
Dr.Anand, physician from Thiruvarur shares the most common questions his patients have about hypertension.
Dr Anand, physician from Thiruvarur, talked about the importance of physical activity in preventing and controlling hypertension. He shared some of his patients’ common questions such as ‘how can our younger generation be hypertensive while his/her ancestors who did not have enough awareness about medical issues led healthy lives ?’ He explained that “50 years ago, people walked everywhere, even for distances of 5-6 kms. But now even for a distance of 100m we prefer to take our bikes”.
Our ancestors were forced to be physically active all the time. But technological innovations have made us choose convenience over health.
CSOs, experts and students from various districts of Tamil Nadu
Dr.Anita Kadagad, a certified ayurveda practitioner explained the issue of hypertension from an ayurvedic context. She said that treatment for hypertension is available in ayurveda as well since it is not a modern issue and only a part of the ageing process. She also added that she combines ayurveda with allopathy after consultation with appropriate doctors. However hypertension among the younger generation, even as young as a 10 year old, is a growing concern largely due to our lifestyle. She added that ayurveda is not being given due importance and there is not enough research done to use ancient techniques in consonance with modern technology and practices. She suggested that it is better to practise yoga as a form of exercise rather than the rigorous bodybuilding routines followed in gyms, since there is an increasing number of cases of stroke and cardiac arrest caused by increased blood pressure as a result of high intensity exercises. She also mentioned the issue of some ayurveda practitioners prescribing allopathic medicines indiscriminately which will give a bad reputation to the field of ayurveda itself. This needs to be addressed and regulated by the government.
Dr. Preetha, Assistant Professor, Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Chennai spoke about the importance of diet in prevention, control and care of hypertension. She discussed the various new methods and techniques of fasting prevalent on social media and the internet promoting easy ways to achieve the desired body shape and weight. She urged people to be wary of what we read on the internet and to consult a doctor before changing a diet. “No matter what combination of diet one follows, moderation has to be the key”. Another popular trend right now is to go back to what our ancestors consumed, like millets, cereals, seeds, etc. However she advised that while we can reduce the portion of our carbohydrate intake to consciously make healthy choices, it is neither possible nor advisable to completely eliminate carbohydrates from our diet. She also advised everyone to stay away from any refined food as the preservatives are harmful for health in the long term.
Ms. Ramya, dietitian and nutritionist from Karnataka, attributed the increase of hypertension cases especially among the younger generation to disruptive lifestyle patterns. “Nowadays we go to bed late and wake up late and not only do we consume unhealthy junk food but we also consume meals at odd times, we sit for long hours in our 9 to 5 jobs, we use cars or bikes to travel everywhere and do not get enough exercise or sun exposure”. She explained that there are trans fats and unsaturated fats present in almost all processed and packaged food that we get in the market and we have to be careful in reading the labels. She advised everyone to allocate at least 20 minutes everyday for physical activity and some stress management exercises such as meditation, yoga, etc.
CAG members along with panellists after the conclusion of the discussion
Dr. Rashmi concluded the session by summarising each of the speakers’ inputs. Some of the points emphasised were that Asians are genetically prone to obesity which is a risk factor for hypertension. Therefore, given this predisposition, we have to be proactive in detecting hypertension at an early stage and getting the right treatment consistently for effective control of the problem. “The main problem in India in hypertension care is the lack of awareness among people about the effects of hypertension. It is not enough that people are educated, but they need to be health literate. Health literacy in India is only 12%”. People need to get treated for hypertension so that it doesn’t lead to renal failure, heart failure or strokes. While she acknowledged the Tamil Nadu government's commendable efforts in ensuring access to healthcare for all through schemes such as ‘Veedu thaedi maruthuvam’, she added that the government needs to exercise political will in taking a proactive role and conducting mass awareness campaigns on the risks of the silent killer - hypertension.