Burden of Hypertension in Myanmar

Hypertension is often called a “silent killer” and most people with hypertension are unaware of the problem because there may have no warning signs or symptoms. Hypertension is a global risk factor associated with substantial morbidity and mortality. There is a direct relationship between blood pressure and risk of cardiovascular disease. For example, as baseline blood pressure increases from below 120/80 mm Hg, there is a stepwise increase in cardiovascular event rates.

Hypertension‐related diseases, the leading causes of morbidity and mortality globally, include: coronary artery disease, heart failure, end‐stage renal disease, and stroke. Furthermore, the global increased consumption of high sodium diets and urbanization has resulted in a dramatic increase in the prevalence of high blood pressure (BP), particularly in developing countries.(1)

Hypertension, a common reason for visiting health care centers, is symptomatic in nature, difficult to identify and for medication adherence. As a result, hypertension is generally not well controlled.

Despite the availability of treatment guidelines and a wide range of therapies, BP control is suboptimal in many countries. Recent data indicate that only around 40% of patients manage to achieve an adequate level of BP control. (2)

The prevalence of hypertension varies across the WHO regions and country income groups. The WHO African Region has the highest prevalence of hypertension (27%) while the WHO Region of the Americas has the lowest prevalence of hypertension (18%). An estimated 1.13 billion people worldwide have hypertension, with most (two-thirds) living in low- and middle-income countries. In 2015, one in four men and one in five women had hypertension. Fewer than one in five people with hypertension have the problem under control. Hypertension is a major cause of premature death worldwide. A review of current trends shows that the number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low- and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations. (3)

A STEP study in Yangon in 2003 determined the prevalence of hypertension and its associated factors. The prevalence of hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive drugs) was 33.8%. The prevalence of prehypertension was 29%.Age, low physical activity, high intake of alcohol, obesity, high level of total cholesterol, and diabetes mellitus were associated with hypertension. Among the hypertensive participants, 53% were aware of their hypertension, and 32% were currently taking antihypertensive medication, but only 11% had their hypertension controlled. The study highlights the low level of control despite the high level of hypertension prevalence in Yangon Division.(4)

A nationwide study in Myanmar revealed that the prevalence of hypertension was high and associated with metabolic, behavioral and socio-demographic factors. The prevalence of hypertension was 30.1 % in males and 29.8 % in females. In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region.(5)

When comparing studies from neighboring countries, the prevalence of hypertension in Myanmar is at the same level as in India (29.8 %) [6], but higher than reported from Thailand (21.5 %)[7], Bangladesh (13.5) [8] and China (26.6 %) [9]. There was higher hypertension estimates in Myanmar than the overall worldwide prevalence. (10) Despite the availability of treatment guidelines and a wide range of therapies, BP control is suboptimal in many countries. Recent data indicate that only around 40% of patients manage to achieve an adequate level of BP control.(11)

In Myanmar, according to the 2014 STEPS survey, 94 % of adult in Myanmar have at least one NCD (Non- communicable diseases) life style related risk factor and 20% of population live with 3 or more NCD risk factors.(12) Eighty-six percent of men and women consume less than the recommended amount of fruits and vegetables per day. Further research has shown that poorer households in Myanmar do not visit healthcare services when needed, and that those affected by chronic illnesses may end up bearing catastrophic health expenditures.(12) The rapidly increasing ageing population in Myanmar is also contributing to the burden of hypertension related chronic diseases.

Ministry of Health and Sports has taken the important steps in addressing Non- communicable diseases in the country to stop an upcoming epidemic by taking the necessary measures such as strengthening the community clinics in rural areas, training of the basic health staff and providing access to preventative medicine, including basic diagnostics and medication and also encouraging life style education.

Healthcare professionals are urged to increase awareness, treatment, and control rates of Non communicable diseases including hypertension. Civil societies should make effort to raise awareness about hypertension at the local and national levels. Furthermore, patients also have to commit to reducing risk factors for hypertension and adhere to medication and treatment recommendations.

With all these coordinated approach, Myanmar will be able to overcome the burden of hypertension and hypertension related diseases in the future complying with World Health Organization recommendations to reduce global hypertension by 25% by 2025.

References:

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Prof Myint Han

MBBS, M Med Sc(Int Med),MRCP(U.K), FRCP(Edin),Dip Med Edu, President  Myanmar Hypertension Society (MHS)