e4 Abstracts

SPECIAL SATELLITE SYMPOSIUM 03

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A SSA 03-1 PREVALENCE AND MANAGEMENT OF
Y HYPERTENSION IN SOUTHEAST ASIA
L Rafael Castillo. Cardiology-Internal Medicine, Manila Doctors’ Hospital, Adven-
E tist University of the Philippines College of Medicine, Philippines
C Similar to the trend worldwide, hypertension (HTN) is also the single most at-
T tributable cause for mortality in South-East Asia (SEA). But while in developed
U regions, the prevalence of HTN appears to be stabilizing or decreasing, the rates in
R SEA continue to rise. Around a third of the adult population in SEA have elevated
E blood pressure (BP) with nearly 1.5 million deaths (9.4% of total deaths) attribut-
able to HTN annually.
In several countries in SEA, awareness level of HTN is less than 50% but in the
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community,” Bangladesh Medical Research Council Bulletin, vol. 28, no. 1, pp.
7–18, 2002.
6. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. Primary
prevention of hypertension. Clinical and public health advisory from the national
high blood pressure education program. JAMA; vol. 288 no. 15, pp. 1882–1888,
2002.
7. World Health Organization, Regional Office for South East Asia. Report of
noncommunicable disease risk factor survey, Myanmar Document.
8. Aekplakorn W, Sangthong R, Kessomboon P, et al. Changes in prevalence,
awareness, treatment and control of hypertension in Thai population, 2004–2009:
Thai National Health Examination. Survey III.
9. Sison J, Arceo LP, Trinidad E, et al. Philippine Heart Association-Council on
Hypertension Report: Survey of Hypertension and Target Organ Damage (PRE-

more affluent countries in the region, awareness ranges from 56% to 70%. Of
those aware that they have hypertension, about half are on treatment, following
the global rule of halves in HTN. Control rates to BP levels below 140/90 mmHg
remains dismally low.
HTN is also a common comorbid condition with type 2 diabetes mellitus (T2DM)
in the region, with HTN coexisting in 40%-60% of individuals with T2DM, and
vice-versa. These dual problem likely accounts for the increased deaths due to
cardiovascular disease (CVD), which remains the leading cause of mortality.
At least seven countries in the region have standard national guidelines for the
management of hypertension, with some of these countries initiating efforts at
reducing salt intake at the population level. These efforts need to be scaled up and
adopted by the other countries in SEA.
Considered an urgent public health problem, barriers to effective prevention and
control remain a major challenge in the region. These barriers include cultural
norms and practices that promote unhealthy behaviors and misconceptions about
HTN, the lack of an enabling environment for healthy lifestyle practices, increased
tobacco use, disparities in healthcare with inadequate access for early detection
and treatment especially primary healthcare facilities, high out-of-pocket cost of
treatment, and generally poor adherence to treatment.
Majority of the countries in SEA have already strengthened their public educa-
tion campaigns and surveillance systems to increase awareness to HTN and other
cardiovascular risk factors, and improve management and control. However, pre-
vention and control of hypertension is complex, and has to be approached via a
multi-sectoral collaboration.
Professional cardiovascular organizations, together with the rest of civil society
can help convince their respective policy-makers and governments to increase
allocation of resources for HTN and CVD control programs, particularly primary
healthcare approaches. A strong-willed health leadership is imperative to effec-
tively execute population-based integrated approaches that target the risk factors
of HTN, especially increased salt in processed foods and the other mentioned
barriers to prevention and control.
If these programs and interventions are sustained, this will definitely help achieve
the ’25–25’ vision or goal of global cardiovascular organizations including the
International Society of Hypertension, that is, a 25% reduction in the prevalence
of HTN and its related complications by the year 2025 in SEA and worldwide.
References:
1. World Health Organization. Global status report on noncommunicable diseases
2010. Geneva: WHO, 2011.
2. World Health Organization, Regional Office for South East Asia. Report of ex-
pert meeting on population sodium reduction strategies for prevention and control
of noncommunicable diseases in the South East Asia Region: 11–13 December
2012, New Delhi, India. New Delhi: WHO SEARO, 2012.
3. Mohan V, Deepa M, Farooq S, et al. “Prevalence, awareness and control of hyper-
tension in Chennai: the Chennai Urban Rural Epidemiology Study (CURES-52),”
Journal of Association of Physicians of India, vol. 55, pp. 326–332, 2007.
4. Suriyawongpaisal P, “Cardiovascular risk factor levels in urban and rural Thai-
land: the International Collaborative Study of Cardiovascular Disease in Asia
(InterASIA),” European Journal of Cardiovascular Prevention and Rehabilitation,
vol. 10, no. 4, pp. 249–257, 2003.
5.Sayeed MA, Banu A, Haq JA, et al. “Prevalence of hypertension in Bangla-
desh: effect of socioeconomic risk factor on difference between rural and urban
SYON 2-TOD) -- A Report on the Prevalence, Awareness,Treatment Profile and
Control Rate of Hypertension. Philippine Journal of Cardiology, vol. 35 no. 1,
pp. 10–19, 2007.
SSA 03-2 PREVALENCE AND PREDICTORS OF RESISTANT
HYPERTENSION IN SOUTHEAST ASIA
Yook Chin Chia. University of Malaya, Ministry of Higher Education, Malaysia
Prevalence and predictors of resistant hypertension in Southeast Asia
Yook-Chin Chia Mbbs Fafpm Frcp (Lon) Department of Primary Care Medicine,
Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur , Malaysia email
chiayc@um.edu.my
Hypertension is the leading cause of mortality worldwide. It is highly prevalent
throughout the world.Even in regions liike South-East Asia (SEA) which has been
perceived to be less prone to cardiovascular diseases, the prevalence of hyperten-
sion has been reported to be around 35%. (1) Awareness and control of hyperten-
sion in SEA is also low, both being less than 50% each. (2)
Control of hypertension is an interplay between patients, doctors and system fac-
tors. One of the reasons for poor control of hypertension is resistant hypertension.
Resistant hypertension is defined as blood presure that remains above goal despite
being on three concurrent anti-hypertensive medications preferbaly one of which
is a diuretic. (3)
True resistant hypertension should be differiented from secondary hypertension
and pseudo-resistant hypertension. Resistant hypertension is almost always multi-
factorial in aetiology. The exact prevalence of resistant hypertenion even in devel-
oped countries is not known It has been estimated that it is as high as 20–30% in
clinical trial patients (4)
Not many studies about resistant hypertension have been done in SEA but one
done in an outpatient clinic in Thailand found it to be 7.82% Another study also
done in a primary care clinc in Malaysia on 1217 patients with hypertension found
the prevalence of resistant hypertension to be 8.8%. (6) Here it was found that the
presence of chronic kidney disease was more likely to be associated with resis-
tant hypertension (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.56–5.35).
Other factors like increasing age, female gender, presence of diabetes, obesity and
left ventricular hypertrophyage which have been found to be predictors of resis-
tant hypertension in other studies in the west were not seen in this study. There are
various reasons for these findings
But whatever the factors are that are associated with uncontrolled hypertension,
the task is to sort out true resistant hypertension from pseudo-resistant hyperten-
sion and secondary casues of hypertension which may be treatable. A concerted
effort is needed to reduce the BP in resistant hypertension. Failure to do so would
mean a substantal increase in CV risk for the patient.
References:
1.Global status report on noncommunicable diseases, 2010. Geneva, World
Health Organization 2011. http://www.searo.who.int/entity/world_health_day/
leaflet_burden_hbp_whd2013.pdf
Last accessed 1 July 2016
2.Anand Krishnani , Renu Gargii and Athula Kahandaliyanageiii Hypertension in
the South-East Asia Region: an overview Regional Health Forum – Volume 17,
Number 1, 2013

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.