Number of people with hypertension expected to rise globally, projected to be significantly higher in South Asia

• Number of people with hypertension projected to increase to 1.5 billion from 1.1 billion worldwide; significant impact in South Asia.

• Half-day Forum on Hypertension and Cardio-Metabolic Diseases was held in Colombo today, convening key government, donor, research and global health stakeholders to identify efforts across Bangladesh, Pakistan and Sri Lanka to prevent, manage and reduce the prevalence and risk of hypertension and non-communicable diseases (NCDs) in South Asia.

 

COLOMBO, Sri Lanka, 1 October 2018– Hypertension is the leading cause of cardiovascular and kidney diseases and over 1.5 billion are expected to be affected by hypertension by 2025. This is especially adverse in South Asia given that the prevalence of hypertension is already at 40 percent. In Bangladesh, three out of four individuals have a risk of developing cardiac disease that can be preventable by simple means; hypertension is one such risk. According to the World Health Organization (WHO), one out of three adults older than 35 years of age has hypertension, but half of them are not aware of it.

A policy forum held today on Hypertension and Cardio-Metabolic Diseases in Colombo observed government ministers, policymakers, economists, researchers and representatives of global health agencies at a single table, addressing steps to prevent, pre-empt and treat hypertension and related co-morbidities, including diabetes, cardiovascular and kidney disease.

The half-day forum, was officiated by Dr. Harsha de Silva, State Minister for National Policies & Economic Affairs, Government of Sri Lanka, and included presentations and panel discussions involving Ministers of Health from the study countries in addition to key stakeholders from the research, academic and health sectors. Dr. Aliya Naheed, Head, Initiative for Noncommunicable Diseases, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b); Dr. Abdul Alim, Deputy Program Manager, Non-Communicable Disease Control (NCDC) Programme, Directorate-General of Health Services (DGHS); and Professor Dr. SM Mustafa Zaman, Secretary General, Association of Physicians of Bangladesh, represented Bangladesh at this policy forum.

Prof. Tazeen Jafar, from Duke-NUS’ Health Services & Systems Research and overall lead investigator of the multi-country Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) study, co-hosted the Forum and shared, “Up to three out of four adults with hypertension in South Asia have poorly controlled blood pressure, and one-third have co-existing diabetes. This is very concerning as complications, including heart attack, stroke, and kidney disease, tend to manifest 5-7 years earlier in South Asians than in Caucasian European populations. COBRA-BPS study is evaluating novel, low-cost solutions for hypertension control and cardiovascular risk reduction in primary healthcare systems in rural communities in South Asia.”

Dr. Naheed, country principal investigator for the COBRA-BPS study in Bangladesh, said, “The beauty of COBRA-BPS’ strategy is that it was adapted into the existing government health system and the implementation of the interventions was driven by grass-root level community health workers and physicians in primary health care facilities. High-level officials from DGHS and policymakers in Bangladesh showed their enthusiasm for the COBRA strategy as it is fully aligned with the operational plan of the 4th Health, Population and Nutrition Sector Programmme (2017–2022).Therefore, enhancing the scalability of the COBRA strategy in Bangladesh is quite feasible.”

Professor Dr. Zaman stated, “Hypertension and diabetes are conditions that, once diagnosed, need lifelong treatment, otherwise patients may end up with disability or even death. As such, a simple treatment protocol is required, which includes cheaper drugs so that patients, particularly from low socio-economic conditions, can afford to continue treatment for life. The Government of Bangladesh is currently developing a simple treatment protocol for physicians to standardise clinical treatment at primary health care facilities, and improve the quality of care.”

Dr. Alim explained, “The Government has adopted various plans as part ofa new five-year action plan on non-communicable diseases to reduce mortality and morbidity from NCDs through the control of risk factors and improvement of health service delivery. COBRA is a simple and feasible strategy that can be integrated into the existing health system of Bangladesh at low cost.”

Dr. Sania Nishtar, co-chair, WHO Independent Commission on the UN High-Level Meeting on Prevention and Control of NCDs, underscored the need for universal health access to include hypertension and diabetes care for all segments of the population.

Prof. Joep Perk, from the School of Health & Caring Sciences, Linnaeus University; Ms. Jill Jones, Head of Global Health Strategy, Medical Research Council, UK; Prof. Kate Hunt from the University of Glasgow, UK; Prof. Shah Ebrahim from London School of Hygiene & Tropical Medicine, UK; and Dr. Richard Smith, Chair of icddr,b Board of Trustees, moderated the sessions and panel discussions. Dr. Shanthi Mendis, a former WHO adviser on NCDs, Prof. Jafar, as well as representatives from the Ministry of Health, World Bank, WHO, professional societies, and policymakers from Bangladesh, Pakistan, Sri Lanka, as well as global researchers in hypertension spoke at the event.

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NOTES TO EDITORS

Contribution of COBRA to the government health system

The COBRA-BPS trial started in 2016; involving more than 2,500 individuals with hypertension from Bangladesh, Pakistan and Sri Lanka. The study found that low-cost multi-component intervention models involving health workers and doctors are a feasible strategy to combat the rising rate of cardiovascular diseases in Bangladesh. The COBRA-BPS study also reported a very high prevalence of uncontrolled blood pressure, which provides compelling evidence to emphasize focus on early diagnosis and management of hypertension in the rural communities in Bangladesh.

The COBRA-BPS study is funded by the UK’s Medical Research Council (MRC), Wellcome Trust, Department for International Development (DFID), National Institute for Health Research (NIHR), and the UK Government’s Global Challenges Research Fund (GCRF). The study is led by Prof. Jafar and her team at Duke-NUS Medical School, with data management and statistical analysis supported by the Singapore Clinical Research Institute (SCRI), in partnership with Dr. Naheed from icddr,b, Dr. Imtiaz Jehan from Aga Khan University, Pakistan, and Prof. Asita de Silva from the University of Kelaniya, Sri Lanka.

About the International Centre for Diarrhoeal Diseases Research, Bangladesh

icddr,b is an international public health research institution based in Bangladesh. Established in 1960, icddr,b has been at the forefront of discovering low cost solutions to key health challenges facing people living in poverty and provides robust evidence of their effectiveness at a large scale. Dedicated to saving lives through research and treatment, icddr,b addresses some of the most critical health concerns facing the world today.

Find out more at www.icddrb.org  or follow @icddr_b

About Duke-NUS Medical School

Duke-NUS is a partnership between Duke University School of Medicine and the National University of Singapore (NUS).

In 2005, with support from the Singapore government, NUS and Duke University, two academic institutions with strong track records in research and education, committed to combine the unique medical education curriculum at Duke University School of Medicine with the academic rigour and rich resources offered by NUS, and to offer students an enriching and innovative medical educational experience.

Duke-NUS is located on the main campus of the largest healthcare group in the country, Singapore Health Services (SingHealth). This group collectively delivers multi-disciplinary care among 42 clinical specialties across a large network of hospitals, national specialty centres and polyclinics. Together, Duke-NUS and SingHealth constitute a leading, world class Academic Medical Centre embodying the goal of delivering the highest levels of patient care, education and research.

For more information, please visit www.duke-nus.edu.sg