Close to four out of 10 (37%) adult Filipinos have hypertension (high blood pressure), according to the latest Philippine Heart Association (PHA) national survey PRESYON-4. Hypertension is one of the leading causes of sickness and death in the Philippines. It is a major risk factor for heart attack, stroke, and kidney disease, which are among the top killer diseases in the country.
Blood pressure (BP) is the pressure exerted by the blood as it pushes against the walls of our arteries, which carry blood from our heart to other parts of our body. Our BP normally rises and falls throughout the day. According to the Philippine Society of Hypertension (PSH), the normal BP for adult Filipinos is less than 120/80 mmHg, while 120-139/80-89 mmHg is borderline hypertension. A BP of 140/90 mmHg or above, typically taken in the doctor’s clinic at least twice on two separate days, is hypertension.
The best way to lower your risk for hypertension is to lead a healthy, physically active lifestyle. Factors that increase a person’s risk for hypertension include older age, genetics, being overweight or obese, not being physically active, a high salt diet, and excessive alcohol intake, the World Health Organization (WHO) stated. Smoking causes a temporary rise in blood pressure.
In most cases, hypertension has no warning signs or symptoms, and many people do not know they have it. Indeed, almost half of the PRESYON-4 respondents were not aware they had hypertension. Measuring your blood pressure is the only way to know whether or not you have hypertension. People with severe hypertension (usually 180/120 mmHg or higher) can experience severe headaches, chest pain, dizziness, difficulty breathing, nausea, vomiting, blurred vision or other vision changes, anxiety, confusion, buzzing in the ears, nosebleeds, and an abnormal heart rhythm.
Lifestyle modification is the first line of treatment for hypertension and is synergistic to the therapeutic effects of anti-hypertension medicines, the PSH said. It should include eating a healthy, low-salt diet; losing excess pounds and maintaining a healthy weight; being physically active (getting at least 30 minutes of moderate physical activity on most days of the week); quitting smoking; and reducing and managing stress.
The AHA recommends limiting sodium intake to 2,300 mg per day (about roughly half a teaspoon of table salt) in most healthy individuals and 1,500 mg per day in people with prehypertension (borderline hypertension) or hypertension. The PSH recommends the Dietary Approaches to Stop Hypertension (DASH) meal plan which is low in sodium and high in dietary potassium for all patients with hypertension without renal (kidney) insufficiency. The DASH diet is rich in fruits, vegetables, low-fat dairy, fish, whole grains, fiber, potassium, and other minerals at recommended levels and low in red and processed meat, sugar-sweetened foods and drinks, saturated fat, cholesterol, and sodium.
The doctor may prescribe one or more anti-hypertension medicines to help the patient reach target BP, which may depend on what other health conditions (comorbidities) the patient has. Medication adherence refers to whether patients take their medications as prescribed by their doctor (e.g., twice daily), as well as whether they continue to take a prescribed medication.
A systematic review by Gutierrez and Sakulbumrungsil published in 2021 in the journal Clinical Hypertension found that healthcare system-related factors that promote medical adherence among Filipino patients with hypertension are good patient-health provider relationship, accessibility of health services, use of specialty clinics and programs for hypertension, and health insurance.
Socio-economic factors found to be negatively associated with adherence are younger age, single civil status, low educational attainment, and unemployment. Patient-related factors that hindered adherence are low health literacy and awareness, knowledge on hypertension, attitude towards hypertension, self-efficacy, and social support. Adherence was also suboptimal in patients with low illness perception and no comorbidities.
The authors recommended focusing on the identified healthcare system-related factors to implement interventions and conduct further research to increase anti-hypertension medication adherence among Filipino patients. They also suggested local doctors screen their hypertensive patients for the said factors associated with low adherence in order to provide them with customized advice and help improve their medication adherence.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
