Chronic disease is a major problem in South Africa. To try to understand it better, we analysed around 700 000 chronic claims sent by General Practitioners (GPs) and came across an interesting observation: primary hypertension accounted for approximately 40% (or 2 in every 5) of all chronic claims sent. And this is true for all provinces.

What factors contribute to hypertension burden?

1. Overreliance on blood-pressure measurement in doctor’s office

Blood pressure is the most powerful indicator of hypertension. However, measuring it only in the GP’s office may not tell the full story. According to a study by UT Southwestern Medical Centre patients with white-coat hypertension (patients experience a spike in their blood pressure specifically when it is measured at the doctor’s office but not in other settings, such as the home) and masked hypertension (patients that have normal blood pressure readings at the doctor’s office but the experience increases in blood pressure at other times of day or in different settings) may have twice the risk of a heart attack, stroke or other cardiovascular event than compared to people with normal blood pressure.

2. Difficulty in treating resistant hypertension

Patients with resistant hypertension (blood pressure remains uncontrolled in spite of the use of three or more antihypertensive agents) are at increased risk of cardiovascular disease than the general hypertensive population. They require a personalised treatment plan.

3. Efficacy of drugs

There are several substances that can stop anti-hypertensive drugs from working properly. Examples are NSAIDs, sympathomimetic drugs such as nasal decongestants, steroids, oral contraceptives and certain anti-cancer drugs such as anti-vascular endothelial growth-factor therapies. Furthermore, certain patients don’t always respond well to the drugs either.

4. Patient reluctance to change their lifestyle

Despite the dangers of high blood pressure, patients are remarkably ambivalent about the need to comply with recommended treatment and make the necessary lifestyle changes. Studies that have included lifestyle changes such as the Dietary Approaches to Stop Hypertension (DASH) have produced blood pressure reductions similar to those from drug treatment.

Conclusion

Hypertension is a major health challenge both in South Africa and worldwide. If we are to bring down the cost burden of chronic diseases on our healthcare system, we need to address the current hypertension epidemic. We need to manage it better not just through proper diagnosis and treatment, but through programmes that persuade and enable patients to follow the treatment and make the necessary lifestyle changes such as better diet and more exercise.

References:

Tientcheu, D., Ayers, C., Das, S.R., McGuire, D.K., de Lemos, J.A., Khera, A., Kaplan, N., Victor, R. and Vongpatanasin, W. (2015) ‘Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension’, Journal of the American College of Cardiology, 66(20), pp. 2159–2169. doi: 10.1016/j.jacc.2015.09.007

Acelajado, M.C. and Calhoun, D.A. (2010) ‘Resistant hypertension, secondary hypertension, and Hypertensive crises: Diagnostic evaluation and treatment’, Cardiology Clinics, 28(4), pp. 639–654. doi: 10.1016/j.ccl.2010.07.002.

Media24. (2016) Six steps to managing hypertension. Available at: http://www.medicalchronicle.co.za/six-steps-to-managing-hypertension/
(Accessed: 30 September 2016). Champagne, C.M. (2006) ‘Dietary interventions on blood pressure: The dietary approaches to stop hypertension (DASH) trials’, Nutrition Reviews, 64, pp. S53–S56. doi: 10.1111/j.1753-4887. 2006.tb00234.x