June 26, 2009 Combating high blood pressure is a global challenge. But while developed countries have enjoyed reductions in cardiovascular disease over recent decades, Latin America has been less fortunate. In fact new research published in the journal Therapeutic Advances in Cardiovascular Disease shows that high blood pressure is on the increase in many Latin American countries, a situation set to worsen unless immediate action is taken.
Adolfo Rubinstein from Hospital Italiano de Buenos Aires, Luis Alcocer from Universidad Nacional Autónoma de México and Hospital General de México, and Antonio Chagas from University of São Paulo Medical School Heart Institute have detailed the evidence in their article High blood pressure in Latin America: a call to action, and offer specific recommendations to remedy the situation.
Despite major healthcare problems in terms of equity and efficiency in the majority of Latin American countries, the overall health indicators of Latin America's population have been on an upward trend over the last 50 years, a trend that continues today.
Yet as life expectancy increases the most common health issues are shifting from dealing with acute disease to more expensive and complex chronic diseases. The chronic disease scenario is already common in developed countries, evidenced by the fact that cardiovascular disease makes up 11% of the global disease burden, leading to some 17.7 million deaths each year. Rapidly developing nations, like many in Latin America, still have a relatively high burden of infectious and communicable disease. The added increase in cardiovascular disease means these countries shoulder a ‘double burden’ of disease. In fact experts have noted that middle- and low-income regions have a five-fold greater disease burden, but have access to less than one tenth of global treatment resources.
Increasing rates of hypertension and chronic diseases, coupled with expected increases in population growth, then, present a mounting threat to Latin American economies.
“These dismal observations warrant a call to action for improved control of high BP and other cardiovascular risk factors across Latin America,” says Alcocer. “Achieving these ambitious goals will require collaborative efforts by many groups, including policymakers, international organizations, healthcare providers, schools and society as a whole.”
The report provides a comprehensive overview of the burden of high blood pressure across Latin America, but “it alone cannot bring about change,” say the authors. Accepting and instituting core policy changes are key to galvanize action, and results.
In terms of core policy, regional policy makers must be alerted to the benefits of high blood pressure detection and control and make this a major public health priority. Leaders must provide resources to empower and train health professionals to detect, diagnose, treat and control high blood pressure, and these must include effective drugs and interventions. It is vital to launch high blood pressure detection and management campaigns. Education and awareness promotion is another critical step, and must include healthy lifestyle advice, and explain the links to risk factors such as smoking and obesity.
In treatment terms, policy makers must encourage therapeutic drug use based on clinical- and cost-effectiveness, acceptability, and affordability for Latin American countries. Healthcare professionals must manage high blood pressure in the context of other cardiovascular risk factors, and work to ensure treatment compliance and adherence.
Government officials and others bearing the cost must be sold the benefits of campaigns to prevent, identify and treat hypertension. The authors also recommend more research, specifically studies that include Latin American patients in large, long-term, clinical-outcome and epidemiological studies to improve clinical outcomes in specific regional context. This research needs support in the form of funding, including patient-oriented acceptance and compliance issues within the Latin American context.
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- Adolfo Rubinstein, Luis Alcocer and Antonio Chagas. High blood pressure in Latin America: a call to action. Therapeutic Advances in Cardiovascular Disease, June 26, 2009
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