Hypertension a heavy healthcare burden in Asia

The sum of individuals with hypertension is large and the increase in disease prevalence is pronounced, according to cardiology specialist Dr Jorge Sison who spoke at the Asian Pacific Society of Cardiology (APSC) Congress 2018. Consequently, metabolic syndrome is now more prevalent in the region.

World Health Organization estimates show that the global hypertensive population will increase by about 60 percent to up to 1.5 billion between 2000 and 2025, Sison said. Asia is expected to contribute to a significant proportion of this patient population.

As the leading cause of morbidity and mortality, hypertension was responsible for 7.6 million deaths in 2000. Moreover, the condition has emerged as the most prevalent risk factor leading to cardiovascular (CV) events, including coronary artery disease, stroke and heart failure. [Lancet 2002;360:1374-1360; JAMA 1996;275:1571-1576]

According to data from the large international database REACH, hypertension plus other classic CV risk factors are consistent and widespread. In Asia alone, about 87 percent of individuals present with at least three risk factors, which have been reported to be largely undertreated and undercontrolled in many regions of the world. [JAMA 2006;295:180-189]

Sison also noted an increased prevalence of diabetes, another important CV risk factor, in Asia. Touted as the epicentre of diabetes, the region was home to about 231.5 million individuals with elevated blood glucose levels in 2015. China ranked first in the top 10 countries with the highest number of diabetic population with 106.9 million cases.  [https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html]

In the presence of either hypertension or diabetes, the risk of developing CV disease increases by 1.5 and 1.8 times, respectively. When two of these risk factors are in place, the CV risk is 2.8 times higher as compared with having neither. Adding high cholesterol into the mix further increases the risk by 6.2 times. These conditions—high cholesterol, elevated blood pressure and excess blood sugar—make up metabolic syndrome. [Kannel WB. Importance of hypertension as a major risk factor in CV disease. In: Genest J, et al, eds. Hypertension: Physiopathology and Treatment. McGraw-Hill: New York 1977]

“Lifestyle changes have led to increased obesity and metabolic syndrome, [which in turn] contributes to significant CV morbidity and mortality,” Sison said.

In US, the prevalence of metabolic syndrome grew from 25.3 percent during 1988–1994 to 34.2 percent during 2007–2012. The increased likelihood of metabolic syndrome during 2007–2012 was linked to low education level and advanced age.

In Asia, metabolic syndrome prevalence is found in about one-fifth of adults in most countries. This number parallels Western figures indicating that nearly one-fourth of the world’s adult population is affected by metabolic syndrome. [http://www.idf.org/metabolic-syndrome; BMC Public Health 2017;17:101]

Sison pointed out that the proportion of metabolic syndrome components differ by sex. Central obesity and low high-density lipoprotein cholesterol level are predominant in women, whereas elevated blood pressure, hypertriglyceridemia and hyperglycaemia are more common in men.

Strategies aimed at primary prevention are therefore needed to prevent a further increase in the metabolic syndrome epidemic and to reduce the morbidity and mortality associated with the syndrome.