One size does not fit all

IT’S almost a puzzle that despite all the advances in the treatment of hypertension and other cardiovascular diseases (CVD), they remain the leading cause of death in the Philippines and worldwide. Complications related to high blood pressure (BP) is still the No. 1 cause of all deaths.

Prof. Rhian Touyz, president of the International Society of Hypertension, stressed that hypertension is a top priority if the “25:25 Vision” of global cardiovascular societies is to be achieved. The vision aims to reduce CVD by 25 percent by the year 2025.

Many hypertension experts believe this is achievable. The Japanese experience, for example, has taught us that by simply cutting the salt intake of the population to around half, there was a dramatic reduction in the incidence of brain attacks or strokes, which are generally attributable to uncontrolled hypertension.

Gradual reduction

If we can just convince our food makers to gradually cut down the amount of salt (sodium) that they use to process foods (canned goods, bread, etc.), this can go a long way in stemming the tide of hypertension and its related complications in the country.

It doesn’t have to be an immediate 50-percent reduction in the sodium content of processed foods; we can have a gradual 10-percent reduction yearly in the next five years so the consumers’ taste buds can adapt to the low salt. In five years, we won’t even miss the 50 percent less sodium that used to be loaded in processing these foods.

Will the food manufacturers do this voluntarily? That would have been the ideal scenario, and we’ve been cajoling them to do that since I can’t remember when. Our legislators may have to pass a law to give them no other choice but to stop slowly killing the population with a sodium (not to mention a transfat) overload that raises the blood pressure and clogs the arteries.

Dr. Lynn Gomez, current president of the Philippine Society of Hypertension (PSH), and the other officers recently drafted their strategic plan for the next three years, so the PSH could play a more dominant and proactive role in the prevention, treatment and control of high blood pressure in the country.

Such plan obviously requires a lot of resources; hopefully, the Department of Health, with its surplus budget coming from the “sin taxes,” can be receptive to partnering with the PSH, the Philippine Heart Association and other cardiovascular societies in carrying out sustainable programs for health promotion activities that prevent hypertension and CVD.

Various treatment goals

During the convention of the European Society of Hypertension in Paris, which was concluded early this week, the experts debated on the various goals in treating high BP. Although the general recommendation is to achieve a BP of less than 140/ 90 mm Hg, a landmark study published late last year suggested that going lower at less than 120 mm Hg systolic BP would be ideal in improving the cardiovascular outlook of hypertensive patients. That means— less stroke, heart attack and risk of cardiac- related deaths.

How much lower below 140/90 mm Hg remains the subject of debate, and it’s really difficult to give a general recommendation. We just have to balance the expected benefits vis-à-vis the risks of aggressive lowering of the BP, particularly in the elderly.

Trying to achieve a lower BP means using higher doses or more number of antihypertensive drugs, which can cause more side-effects including dizziness and syncope (fainting). This can lead to falls and injuries and other complications of markedly low BPs, not to mention the negative effect on the patient’s quality of life.

So, the doctor will have to individualize treatment goals for individual patients. For the elderly, a systolic BP less than 150 mm Hg is good enough. If they can tolerate lower levels without experiencing side-effects, then that should be acceptable.

For the general population, a BP less than 140/90 mm Hg remains the ‘ sweet spot’ which has a good balance between benefit and risk or side effects.

Lower BP may be aimed at for diabetics and those with chronic kidney problems, especially if they’re spilling out proteins already in the urine (proteinuria), but again, the physician has to weigh the pros and cons, and individualize their treatment goals.

One size does not really fit all in the treatment of high blood pressure and heart diseases.