Turning the tide of Hypertension in Nepal
21st May 2018Lisa Woodward
Turning the tide of Hypertension in Nepal
The Nepal Demographic Health Survey revealed that one in every five adults in Nepal are hypertensive and the prevalence has nearly tripled in last thirty years. Shiva Raj Mishra and Dr Dinesh Neupane spoke to May Measurement Month about the issue of high blood pressure in Nepal and how they hope to use the learnings from May Measurement Month over the last 2 years to help improve hypertension management.
“The burden is higher in urban areas compared to rural areas, and surprisingly even 5.2% of youths (aged 15-29 years) are hypertensive (7.1% male and 4.1% female). Breaking down figures for all people aged 15-69 years by provinces and ecological regions, revealed that people at province-4 (western mid hill and Terai region) (23.9% compared to national average of 17.9%) and those living in hills (20.6% compared to 15.7% living mountains) carry the highest burden of hypertension among the other provinces and ecological zones. The important drivers of hypertension identified were related to: lifestyles, dietary practices, genetics and environment.
Key facts on Hypertension in Nepal
- One in five Nepalese adults are hypertensive*
- One in twenty Nepalese youths are hypertensive*
- Risk of hypertension adds up cumulatively with adoption of multiple unhealthy lifestyles factors
- Only 38% are aware of their hypertension status*
- Only 18% were treated or receiving anti-hypertensive medication*
- Hypertensive aged 25-35 years (84% less), those paid >=50 Nepalese rupees (0.5 USD) for traveling to medicine outlet for refill (83% less) and having ≤10,000 Rupees monthly income (100 USD) (47% less) were less likely to receive anti-hypertensive treatment***
- Of those taking medication, only 9.5% have controlled blood pressure*
Access to blood pressure screening
- 5% of health facilities (public: 93.2% vs private 95.7%) have blood pressure apparatus. But only 1.4% received training****
Build awareness on hypertension
Awareness helps improve uptake of better lifestyle practices. One important way to spread awareness at the community level is by using a role model approach. Role models are people who have outstanding standing at the community and who could pass some good words to encourage people to adopt healthy lifestyle. For example, in this year’s MMM campaign in Nepal, we tried to use multiple approaches. Prof. Dr. Bhagwan Koirala, who saved thousands of lives by doing cardiac surgeries strongly supported our campaign in the initiation days. Additionally, his earlier remarks have stressed upon the need for visiting health workers for hypertension screening.
See YouTube video (Credit, Sandip Paudel, Nepal)
We also used social media platforms such as Facebook and Twitter – recruiting volunteers and mobilizing them. Early results suggest the campaign has been immensely successful.
Increase healthy lifestyle choices
The same approaches: role models and aggressive behaviour change campaigns can be used to spread messages on healthy lifestyle. Given the rich cultural practices of over 30 million people in the country, there needs to be a balance in the approaches not hampering cultural psyche of people. One cannot be asked to leave traditional and homemade recipes rich in carbohydrate, without giving alternatives. Rice, poultry and animal products are all high in fats and carbs, but they have been part of their diet for centuries. Taking out them from the staple is not an easy choice for anyone to make. Therefore, alternatives are must and should be given timely. In this year’s MMM campaign, we are giving lifestyle counselling to high risk groups, those above the cut of 140 mmHg systolic and 90 mmHg diastolic, to engage them in healthy lifestyle practices and seek-out timely health professional advice.
Improve treatment access and adherence
Low treatment access and adherence is a problem in Nepal, like elsewhere in low-income countries, and is directly linked to geographic disadvantage, costs and access to treatment. As a result, the treatment and control rates of hypertension are extremely low. A study conducted by our team entitled “Awareness, Prevalence, Treatment, and Control of Hypertension in Western Nepal” and published subsequently in American Journal of Hypertension found only one in three hypertensive patients were being treated (currently taking medicines), and among those who were being treated, one in seven have normal blood pressure. These barriers in hypertension treatment needs to be addressed timely and adequately taking health system measures.
Scale up screening
Through past studies and guidelines, we have known that a simple hypertension screening among the general as well as high risk population, reduces the risk of future cardiovascular diseases and stroke. Adults aged 18 years or above should be screened for blood pressure routinely at home or a health facility, and those who have cardiovascular disease should be screened every six months. Today, screening opportunities are extremely rare in Nepal. An intermediary management measure and before hypertension screening becomes universal, periodic pop-up (screening) campaigns like MMM should be used to identify cases of hypertension that are not captured in primary care.
The benefits of such screening are two folds: screened people are more likely to engage in healthy activities than rest of the population and screening helps to identify high risk groups and benefits them by overall low risk of future CVD mortality and morbidity. Therefore, without a doubt screening of hypertension is the best-buy for reducing cardiovascular disease risk in Nepal, as it is elsewhere.
Implementing the blood pressure screening campaign in past two years has been a tremendous experience. And, we are proud of what we have achieved. Especially, the participation of young people in this campaign, was a delight to watch. We want to thank the Nepal MMM team, all the volunteers and organizations participating in this year’s campaign. We encourage everyone join this campaign. Together we can turn the tide of hypertension in Nepal.”
Blood pressure screening at Bhatbhateni Area, Kathmandu (A)Ayurveda Campus, Kirtipur (B) and Bindabasini Kaski (C) as part of nationwide May Measurement Campaign in Nepal.
Shiva Raj Mishra, Dr Dinesh Neupane work in cardiovascular epidemiology and access to medicines. Both are affiliated to Nepal Development Society—a non-profit organization based in Western Nepal.
*(Meheta et al., 2018),
**(Neupane et al.,2017),
***(Mishra et al., 2018),
**** (Nepal Health Facility Survey, 2015)