HIGH BLOOD PRESSURE Jamaica’s big problem
THOUGH it is widely held that hypertension is more common in men than women, the reality is very different in Jamaica. In fact, consultant cardiologist Dr Andrene Chung told the Jamaica Observer in a recent interview that women outstrip the men in this Caribbean island, based on the last Jamaica Health and Lifestyle Survey.
“The last Jamaica Health and Lifestyle Survey that was done in 2016 to 2017 showed that the prevalence of hypertension in males was 31.7 per cent, and in females [it] was 35.8 per cent. So it doesn’t seem that there is this male preponderance in Jamaica,” she said.
Dr Chung explained that the United States also does a similar national survey, and
“they do seem to have a slight preponderance of hypertension in younger males”.
“So below the age of 50, more males than females tend to have hypertension, but over the age of 55, just as it is with heart disease in general, it’s sort of equal. As a matter of fact, women even sort of overtake them in the older years,” she said. “We don’t really know why there is this gender difference; there are postulates about the oestrogen in women protecting them, much as it does for heart disease, but it’s not really clear.”
According to non-profit academic medical centre Mayo Clinic, hypertension, also known as high blood pressure, is a condition in which the long-term force of the blood against one’s artery walls is high enough that it may eventually cause health problems, such as heart disease.
As a cardiologist, Dr Chung sees the effects of hypertension. She explained that the difference in Jamaica in relation to the prevalence of hypertension among men and women is likely associated with obesity.
“We know that if you are overweight then you tend to run a higher blood pressure, or if you are hypertensive and you are overweight then your pressure tends to be higher; and we have a big problem with overweight and obesity in Jamaica, and it’s particularly in our women,” Dr Chung, chair of the Heart Foundation of Jamaica, told Your Health Your Wealth.
“So about 54 per cent of Jamaicans — one in two — are classified as overweight or obese, but women are more affected by it, and two-thirds of women are actually classified as being overweight or obese. So this may be fuelling the higher prevalence of hypertension in women,” Dr Chung suggested.
She insisted, however, that singling out one sex is not the way to go because Jamaica has a “big” hypertension problem.
“When we think of hypertension, we don’t really think of it as a male disease or a female disease, so I don’t really think that these proportions are that important. We have a hypertension problem in Jamaica and it’s big, it’s one in three persons,” the cardiologist, who is also the medical director of Partners Interventional Centre of Jamaica, asserted.
She said the country has such a big hypertension problem that “we really want to address it to everybody”.
“The only thing I would say from the point of view of the males is that males are usually more reluctant to take treatment,” Dr Chung explained. “Males, of course, are less likely to come to the doctor.
“Women come to the doctor much more readily and come to check things, men are much more reluctant to do that. And, specifically with relation to hypertension drugs, men have the fear that they’re gonna cause erectile dysfunction and so many do not want to go on to medication. And, even when you prescribe it, they often don’t take it although they tell you they are taking it, so they do run an extra risk in that way because of non-compliance with therapy,” Dr Chung told Your Health Your Wealth.
She explained that there is a risk of erectile dysfunction, but the risk is much less than it used to be.
“... In the older days...we had just a few classes of drugs for treatment, and many of them did cause erectile dysfunction, so that’s where that came from. Nowadays we have so many choices and so many that have actually been investigated in terms of whether they cause erectile dysfunction or not, so what the man should do is have an open and honest discussion with his doctor and ask the questions.
“The doctor should also offer the information, but they [patient] should have an honest discussion about their fears because there are medications they can get that don’t cause that,” she insisted.
In the meantime, Dr Chung reminded Jamaicans that hypertension is called the silent killer for a good reason.
“You do not necessarily know when your blood pressure is high, so you need to check your blood pressure. You need to monitor your blood pressure regularly, whether that’s by visiting your doctor or monitoring yourself at home, as some people do, and if your blood pressure is above the [normal blood pressure of 120 mm Hg/80 mm Hg], then you need to address it.
“You need to start with your lifestyle changes — maintain a healthy weight, have a healthy diet — monitor your blood pressure, and visit your doctor and follow the advice,” the cardiologist said.
HYPERTENSION, which is the medical term for high blood pressure, is often referred to as the silent killer.
This is because one might not necessarily know their blood pressure is high since most people have no signs or symptoms.
According to the Jamaica
Health and Lifestyle Survey for 2016/2017, one in three Jamaicans are hypertensive and four out of every 10 Jamaicans with hypertension are unaware of their status. Also, more and more Jamaicans aged 15 to 74 years old are developing hypertension, as in 2017, 31.5 per cent of individuals in this age group had high blood pressure compared to 20.9 per cent in 2001.
Speaking to the Jamaica Observer in a recent interview, consultant cardiologist Dr Andrene Chung explored how people can reduce their hypertension risk. Chief among the actions that can be taken is making lifestyle changes.
“Maintaining a healthy weight, first of all; people who are overweight tend to run higher pressures. If you develop hypertension, it’s harder to treat, so maintaining a healthy weight
[is important],” she told Your Health Your Wealth.
The cardiologist, who is also chair of the Heart Foundation of Jamaica and medical director for Partners Interventional Centre of Jamaica, said regular physical activity is also important.
“Regular physical activity, not just for weight loss but for the health of your blood vessels, for direct effect on lowering blood pressure, for beneficial effects on other risk factors like diabetes, cholesterol and so on, so regular physical activity [helps],” she said.
The cardiologist also highlighted the importance of a healthy diet.
“So diet from the point of view of weight loss, yes, but also in terms of helping to keep your blood pressure lower. Restricting salt, eating lots of fresh vegetables and fruits, cutting back on things like your starches; processed foods tend to have a lot of salt and ingredients that are not good for us, so definitely a healthy diet,” Dr Chung said.
The consultant cardiologist also said individuals need to know their family history.
“If you come from a family that has a lot of people with hypertension, you are at greater risk of developing it, so the earlier you know that, the earlier you can start monitoring,” she said, adding that regular monitoring is also wise.
“So, every adult over the age of 20 should have at least an annual blood pressure check, and if the blood pressure is found to be borderline then your doctor will usually advise you to check it even more frequently. So you need to be aware of what your numbers are, of where you fall in the spectrum.
“And then, of course, if you are diagnosed with hypertension you must take your medication regularly, you must monitor your blood pressure, you must visit your doctor when you are told to,”
Dr Chung said.
She told Your Health Your Wealth that, as a cardiologist, she sees the effects of hypertension and it’s important to keep it under control.
“Normal blood pressure is 120 mm Hg/80 mm Hg or below.
Once you start going above
120 at the top or above 80 at the bottom, we consider that to be elevated blood pressure. That’s a category in which we don’t usually treat people with medication, but we start to emphasise the lifestyle changes.
“Once your top figure is above 130 mm Hg or your bottom figure is above 80 mm Hg at any point in time, then we consider you to be stage one hypertension... So borderline is going to be somewhere about in the 130/80 to 140/90 range. Once you start to be in that range you need to be very careful, you need to definitely be sticking to these changes that we talked about and you need to take advice; your doctor may decide that you don’t need to start on medication at that point in time.
“Definitely, once you are at 140/90 or above, you are hypertensive and you need to be following the lifestyle changes and probably taking medication if advised by your doctor,” she said.