HOW CHANGING BLOOD PRESSURE TARGETS COULD SAVE LIVES IN SA

HIGH blood pressure, also known as hypertension, is a serious public health threat globally. If uncontrolled it substantially increases the risk of disability and death from stroke, heart attacks and other cardiovascular conditions.

It’s also a huge problem in South Africa – an estimated 35% of people in the country older than 15 have high blood pressure.

But improving blood pressure control first requires figuring out what an ideal blood pressure should be.

Blood pressure has two components: systolic – the amount of pressure in your arteries during the contraction of your heart muscle – and diastolic blood pressure – blood pressure when your heart muscle is between beats.

These two components are written and spoken together as systolic “over” diastolic blood pressure. At the moment in South Africa, people are defined as having high blood pressure if their readings are above 140/90mmhg – normal blood pressure is a reading below this threshold.

The problem is that this level is determined from information collected in settings like the UK or Us,so which target makes the most sense for the South African population?

To answer this question, we used the National Income Dynamics Study. To our knowledge, it’s the only population-wide long-term data set in South Africa.

We followed 4 993 individuals over a six-year period. The main aim was to compare different blood pressure levels with the risk of death that each level carried. We only considered systolic blood pressure (the upper blood pressure number) since it may be slightly more important for future risk of illness than diastolic blood pressure (the lower number). The four blood pressure targets we looked at were 120, 130, 140 and 150mmhg.

We compared the future risk of death between people who had each of these blood pressure readings at baseline. We used this information to simulate the number of total deaths that would be avoided and the share of the adult population of South Africa that would require blood pressure care under efforts to scale up blood pressure conwtroelftoounacdhtiehvaet tthheesegrteaartgeestts.reduction in deaths would come from reducing the upper blood pressure reading to about 150mmhg. There wasn’t a substantial reduction in deaths if people further achieved the blood pressure targets recommended by the new American College of Cardiology and the American Heart Association guidelines (upper blood pressure reading of less than 130mmhg).

There was weak evidence in support of the less than 140 mmhg target recommended by the International Society of Hypertension Global Practice guidelines which are used in South Africa.

This finding is important for clinical practice. Lower targets place a greater treatment burden on patients in the form of additional and potentially higher doses of medications. Our results add to a growing concern that exporting clinical guidance from high-income to low- and middle-income country contexts may lead to inefficient decision-making.

Ultimately, we believe our findings can be useful for setting treatment targets and planning population-wide blood pressure control efforts throughout the country.

TELKOM shares surged the most in more than a year on the JSE yesterday after investors cheered its revenue growth from mobile services in the nine months to the end of December, which cushioned the impact of moribund fixed voice and interconnection revenue.

Telkom shares jumped 12.4 percent to R41.52 in intraday trade before closing at R41.44 on the 40.7 percent growth in mobile service revenue to R12.5 billion from R8.94bn a year earlier. An increase in the number of active subscribers helped group revenue to grow 0.9 percent to R32.43bn.

Chief executive Sipho Maseko (pictured) said the group had delivered a solid set of results where growth was challenging due to Covid-19 and the strained economy.

“Telkom’s broadband-led strategy and the decision to invest in infrastructure ahead of demand enabled us to meet the surge in demand for broadband services,” said Maseko.

He said that strong mobile growth had driven overall growth, coupled with solid sustainable cost management and strong free cash flow generation.

Mobile service revenue growth was supported by the 25.9 percent growth in active subscribers to 14.9 million, and prepaid customers grew by 30.8 percent to 12.3 million.

Telkom said its mobile broadband strategy continued to pay off as yearto-date mobile data revenue grew by 46.2 percent to R9.05bn from R6.19bn a year earlier.

Telkom also posted an improved operational performance, as earnings before interest, tax, depreciation and amortisation jumped by 8.5 percent to R8.6bn, up from R7.96bn a year earlier following cost management.