(MENAFN – The Conversation) High blood pressure, also known as hip fracture, is a serious public health threat worldwide. If left uncontrolled it increases the risk of disability and death from stroke, heart attack and other cardiovascular conditions. It is also a major problem in South Africa – an estimated 35% of people in the country over the age of 15 have high blood pressure. This is expected to increase as the country’s population grows rapidly over in the coming decades.
It is therefore not surprising that the South African government has controlled blood pressure as a health policy priority.
But developing blood pressure control first requires figuring out what blood pressure should be. Blood pressure has two parts: systolic – the level of pressure in your arteries when your heart muscle is contracting – and diastolic blood pressure – blood pressure when your heart muscle is between beats. These two parts are written and spoken together as ‘over’ systolic diastolic blood pressure. At the moment in South Africa, people are described as having high blood pressure if their readings are above 140/90 mm Hg – normal blood pressure is a reading below this level.
The problem is that this level is determined from information collected in situations like the UK or US that have very different living conditions. This can mean that the targets are not very suitable for all populations. But there is not much information from situations in Africa with which you can determine what blood pressure should be.
In our recent research we set out to find out which blood pressure target makes sense for the South African population. We believe this would enable policy makers and public health clinicians to develop more appropriate treatment management and interventions for the population.
Based on our research we concluded that reducing blood pressure to less than 150 mmHg, rather than 140 mmHg, is the most resource-efficient way to save people with high systolic blood pressure (high reading) .
Mobile target
In high-income countries, blood pressure targets were determined by comparing the risk of serious illness in individuals whose blood pressure was reduced – usually by taking blood reduction medications – to different targets, lower. Health experts then decide which target will best balance health benefits against treatment side effects.
For their part, South African policymakers and clinicians have determined treatment targets using guidelines that are largely based on evidence from studies conducted in future countries. into high. However, the numbers living in South Africa may have different baseline conditions and exposure to different environments may affect the link between blood pressure and its effects. could have.
So what target makes sense to the people of South Africa?
To answer this question, we used the National Income Dynamics Survey. To our knowledge, this is the only long-term data set across the population in South Africa.
We followed 4,993 people over six years. The main goal was to compare different blood pressure levels with the risk of death at each stage. We only considered systolic blood pressure (the highest blood pressure number) as it may be slightly more important for future risk of illness than diastolic blood pressure (the lowest). The four blood pressure targets we observed were 120, 130, 140, and 150 mmHg.
We compared the risk of future death between people who had these blood pressure readings at baseline. We used this information to simulate the number of total deaths that would have been avoided and the proportion of South Africa’s adult population that would require blood pressure care under efforts to increase blood pressure control to meet the targets. to achieve that.
We found that the greatest reduction in mortality would come from reducing high blood pressure readings to around 150 mmHg. There was no significant reduction in mortality if people met the blood pressure targets recommended by the new American College of Cardiology and American Heart Association guidelines (blood pressure readings lower than 130 mmHg).
Weak evidence supported the target of less than 140 mmHg recommended by the International Hypertension Association Global Practice guidelines currently in use in South Africa.
This finding is important for clinical use. Lower targets place a greater treatment burden on patients in the form of additional and potentially higher doses of medication. Lower targets also require clinicians to put more effort into each patient to help individuals achieve and maintain lower blood pressure levels.
Our decisions also have an important impact on policy makers. Lower targets need to control blood pressure for a much larger section of the population.
For example, we found that an augmented ideological effort to treat everyone in South Africa with blood pressure above 150mmHg to levels below this would require care. to 16% of adults. Fifty people had to be treated to avoid a single death. In contrast, a scale effort to treat all to a target of 130 mmHg required the care of 43% of the adult population. Seventy people had to be treated to prevent a single death.
For this reason, the more conservative (higher) targets are more cost effective. These require fewer resources for each death avoided. More conservative targets may also be more reasonable to achieve as they require fewer total resources to meet.
Keep it local
Our findings add to growing concern that the export of clinical guidance from the contexts of a low- and middle-income country could lead to ineffective decisions. .
Ultimately, we believe our findings can be instrumental in setting treatment targets and planning blood pressure control efforts across the country.
Other researchers who contributed to the research study were Alpha Oumar Diallo, Mohammed K. Ali, Pascal Geldsetzer, Emily W. Gower, Trasias Mukama, Ryan G. Wagner, and Maarten J. Bijlsma.
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