Addressing hypertension in South Africa

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An imploding epidemic of chronic non-communicable diseases is threatening national healthcare systems sustainability, the economy of the country and claiming many preventable and avoidable deaths.

Hypertensive disease in pregnancy is the leading cause of direct maternal deaths in South Africa. Pre-eclampsia is a multi-organ disease unique to pregnancy, clinically evident by the presence of hypertension and proteinuria. In severe form, pre-eclampsia is the most common cause of maternal and perinatal morbidity and mortality.

In adolescents, hypertension is increasingly linked to obesity. Globally, poor diet and a lack of exercise in children is causing an epidemic of obesity, with an early onset of hypertension and Type 2 diabetes. Early recognition of this hypertension will be an important motivation for children and their parents to institute important lifestyle changes.

Hypertension is abnormally high blood pressure. It is a condition in which the force of the blood against the artery walls is too high. This causes the heart to work harder than normal, which is dangerous. Hypertension is a global public health concern and a marker of the complex cardiovascular malady; furthermore, it is an independent and preventable risk factor for morbidity and mortality.

Worryingly, the burden of hypertension is complicated by under-diagnosis, poor treatment and control, as a result of its asymptomatic nature. This is, however, a risky adventure as undiagnosed and uncontrolled hypertension potentially increases the chance of developing target organ damage and other life-threatening conditions, whereas early diagnosis affords the opportunity for prompt intervention.

Several factors are responsible for the development of hypertension. Among these are behavioural factors such as unhealthy diets, obesity, physical inactivity, harmful alcohol and tobacco use. However, work-related factors such as stress and sedentary behaviour have also been implicated in the aetiology of hypertension.

The most common cause of resistant hypertension in South Africa is probably non-compliance (adherence) with lifestyle and medication; this includes the unavailability of medication and other drug-related causes. Last year an estimated 42% to 54% of South Africans were suffering from hypertension and this figure is expected to increase exponentially in the absence of effective response to halt this potential epidemic.

A study by Wits University scientists revealed that South Africa has the highest prevalence of hypertension in southern Africa, as well as the largest number of people whose blood pressure is still not controlled, even while on treatment. The current perspective of looking at addressing hypertension from public health lens is deeply problematic.  The prevention and control of hypertension require a bold and broad strategic and innovative approaches that look at hypertension from a socio-economic perspective and response.

However, the mechanisms of some sociodemographic and risk factors associated with the inconsistency between hypertension awareness, treatment and control in different subgroups of the population need to be further researched and explored.

There is a need for models that addresses the roles of healthy public policy, healthy living environments, healthy communities, reorientation of health services delivery towards prevention and management of chronic illness, support for improving clinical decisions, empowerment of communities to prevent and self-manage chronic disease, partnerships of stakeholders and information systems to track the impact of interventions and identify prevention and care delivery model gaps.

There is need for enhancing strategic approaches to the prevention and control of hypertension, as a national and global socio-economic issue. This day must serve as a call to action for broad-based efforts to improve hypertension awareness, treatment, and the proportion of patients treated and controlled in South Africa.

We need to move away from a single disease approach towards integrated preventative and management of co-morbidities of epidemics in South Africa. These approaches need to ensure that communities are at the centre of response to chronic diseases for honourship, impact and sustainability. Hypertensive patients have the right to be informed about the status and progress of their condition. The main objective of patient education is to empower individuals to participate actively and ensure the quality of the management of their hypertension.

Effective, honest and open two-way communication between the care provider and the patient is critical to the management of chronic life-long conditions. Acquisition of communication and counselling skills by health professionals is essential – preferably in the language of the target population.

The understanding of health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and clean water, sanitation, food, housing, health-related information and education, and gender equality.

It is therefore for this reason that the Healthy Living Alliance (HEALA) has undertaken to strive for the empowerment of all those who live in South Africa to make healthy food and lifestyle choices to prevent obesity and non-communicable diseases.

HEALA will continue to campaign and advocate for progressive policies and regulations that promote and protect health, dignity and lives of all people living in South Africa. These include campaigning and advocating for 20% Health Promotion Levy (HPL) on sugary drinks, effective Front of Package Labelling on food with excess salts, sugar and fat and protecting children from advertising of unhealthy food and beverages.

Lawrance Mbalati is a Programme Manager at HEALA.