Port of Spain, Trinidad and Tobago. 16 May 2023. “Hypertension, also known as high blood pressure, is the number one risk factor for illness and premature death from cardiovascular disease, and one of the most common non-communicable diseases (NCDs) in the Caribbean region. This disease may go undetected, thus getting your blood pressure checked frequently is especially important, so that timely treatment including lifestyle changes and/or medication can be started to reduce progression to complications,” remarked Dr. Joy St. John, Executive Director of the Caribbean Public Health Agency (CARPHA), in observance of World Hypertension Day.
The non-Latin Caribbean has the greatest mortality rate from cardiovascular disease (418 per 100,000 inhabitants).
A study that examined 10-year mortality trends in 20 English and Dutch speaking Caribbean countries/territories, discovered that cardiovascular disease accounted for most deaths (13-25%) with Montserrat, Bermuda and Trinidad and Tobago having the highest percentages. In the adult population aged 30-79, the regional age-standardized prevalence of hypertension was 35.4% in 2019. It was more substantial in men (37.6%) compared to women (33.3%). Furthermore, the top 20% of countries in the world with the highest prevalence included countries in the Caribbean with Dominica (47.7%) having the highest prevalence and Belize with the lowest prevalence (38%) (Pan American Health Organization, 2021).
Uncontrolled blood pressure can cause serious health problems such as heart failure, stroke, damage to the kidneys and the back of the eye. Although blood pressure usually increases with age, hypertension is preventable and treatable. According to the World Health Organization, although hypertension is an easy condition to diagnose and treat, globally about 46% of adults remain unaware that they have this condition.
The risk factors contributing to hypertension are similar to those of other major chronic NCDs such as cancer and diabetes. Behavioural and lifestyle-related factors - eating too much salt, being overweight and not getting enough exercise, excessive use of alcohol and smoking of tobacco - can put people at a higher risk for developing high blood pressure.
“While there is no cure for hypertension, making lifestyle changes can greatly enhance your quality of life and reduce your risk of developing heart disease and stroke,” stated Dr. Heather Armstrong, Head of Chronic Disease, and Injury at CARPHA. She stressed the importance of maintaining a healthy lifestyle at all ages. “That means reducing your salt intake, eating a healthier diet rich in fruits and vegetables, getting enough exercise and maintaining a healthy body weight for your height and age, and avoid the harmful use of alcohol.”
When your blood pressure is too high for too long, it damages your blood vessels. A big part of preventing stroke and heart disease is simply being aware of your blood pressure - know your numbers. Check your blood pressure numbers regularly to be assured of good health. If you have been diagnosed with hypertension, staying on the treatment prescribed by your doctor or health provider is essential, especially if you have other risks like diabetes, high cholesterol, or are a cigarette/tobacco user.
Hypertension, if not adequately managed, can have significant negative economic and social impact on the individual, the population, and the country. Combined and coordinated efforts at local, national, regional, and global levels are needed to increase awareness of the dangers of high blood pressure and address the risk factors associated with this silent killer.
Through combined and coordinated efforts, CARPHA is committed to continuing its work to increase awareness of the dangers of high blood pressure and to address the risk factors associated with the disease. CARPHA’s work in Integrated Disease Management includes the publication and implementation of clinical guidelines to support the diagnosis, management and care of diabetes and hypertension, disease conditions which are major risk factors for the development of cardiovascular diseases. With the support of the French Development Agency (L’Agence Française de Développement-AFD), CARPHA is spearheading the revision of a clinical guideline for the management of hypertension in primary care in the Caribbean.
Additionally, CARPHA has developed a Regional Framework for Reduction of Sodium in Caribbean populations, a major risk factor for hypertension that aims to Change the food environment, Educate the population, strengthen system capacity, and Assess progress (CESA). Salt awareness programs, webinars and messaging systems have been put into place to further educate and support CARPHA Member States.
Other CARPHA-driven policies and guidelines include the implementation of the six-point policy package developed to combat childhood obesity in the Region. It aims to create a healthy food environment, such as the need for mandatory food labelling to help consumers correctly, quickly, and easily identify products that contain excessive amounts of critical nutrients. The six-point policy addresses nutrition standards and guidelines for schools, food marketing, quality of the food supply, development of policies, and food chain incentives. Recently, a training workshop was held to provide guidance to CARPHA Member States in developing policy briefs for the elimination of industrially produced trans-fatty acids. The Agency launched a Food Security and Nutrition Surveillance (FNSS) online course in 2023 to aid Member States in strengthening their existing food and nutrition surveillance systems.
The surveillance of non-communicable diseases such as hypertension and their associated risk factors, morbidity, mortality, and social health determinants that influence their prevalence, is high on CARPHA’s public health agenda. The Caribbean (Regional) NCD Surveillance System hosted on the District Health Information System version 2(DHIS2) platform has been introduced via a training workshop to allow for more regional monitoring and analysis of NCDs amongst CARPHA Member States. These training sessions highlight the best practices, issues, and challenges when collecting NCDs data and reporting before and after guidelines and policy implementation.
CARPHA encourages people to quit the use of all tobacco-based products, avoid the harmful use of alcohol, get more exercise, and walk regularly, eat more fruits and vegetables, cut back on salty, sugary, and fatty foods, maintain a healthy weight, and minimize stress to lower your risk of developing high blood pressure. If you are a person living with hypertension (PLWH) and taking your medication, alert your health care provider of any changes from your baseline. By engaging in these practices, even if you have hypertension, it is possible to get it under control with lifestyle changes and the aid of medicines.