Hypertension Part 2: High Blood Pressure impacting Parts of the Pacific

Author: Sukheshni Nand

Hypertension is the measure of the force of blood against your artery wall and it is Fiji’s second most common heart disease [1]. Anyone can develop hypertension; it increases your risk of heart attack or stroke [1]. Unfortunately, there are no warning signs or symptoms for high blood pressure, which is why it is important to get your blood pressure checked with a health professional. Even though blood pressure can go up and down throughout the day, if it remains high for a long period of time (around 3 months) that would mean that you have high blood pressure [1].

The Republic of Fiji forms part of Melanesia in the South Pacific and is comprised of more than 330 islands. Since the mid-twentieth century, Fiji has experienced the demographic and epidemiological transitions, involving declines in mortality, especially infant and under-five deaths, and a change in major causes of death from infection/under-nutrition to noncommunicable disease [2]. According to the 2018 WHO data, hypertension Deaths in Fiji reached 381 or 6.50% of total deaths [3]. "The age adjusted Death Rate is 59.07 per 100,000 of population ranks Fiji #2 in the world." [3]. A 2016 Empirical survey data collected for Fijians aged 25–64 year (nationally representative for age group, sex, ethnicity, and urban–rural residence) demonstrated a statistically significant and continued increase in hypertension prevalence in both sexes of the i-Taukei and Indian populations during 1980–2011 [2].

The most affected population group was [2]:

• i-Taukei men who had the highest level of hypertension prevalence in 2011, and had the greatest increase over 1980–2011 in hypertension prevalence and SBP.

Amongst the women,

• The i-Taukei population had the highest level of hypertension prevalence in 2011;

• However, Indian women had the greatest increase during 1980–2011 in these measures.

Unfortunately, due to the differences in the definition of hypertension, previous attempts at comparing BP means and prevalences from cross-sectional surveys have been hindered [2]. These differences in definition have made it difficult to accurately establish trends over time.

This 2016 study as well as previous population studies of BP in Fiji dating back to the 1950s have identified an association between increasing age and increase in BP means and hypertension prevalence in both sexes and ethnicities [4,5,6,7]. Increased BP with increasing age has also been found in other Pacific Islands, including Samoa and Tonga, and elsewhere, including Australia [2]. However, "some previous studies of less modernized populations indicate no significant increase in BP with age in the Pacific, including the northern Cook Islands (Pukapuka), Tokelau, Wallis Island, and elsewhere, including Brazil and Kenya, highlighting that increased BP may not be an inevitable consequence of aging" [2]. Hence highlighting urbanization as a distant (or ultimate) risk factor of hypertension [2]. Risk factors, including salt intake and obesity contribute significantly to increases in BP and hypertension prevalence [2]. A 1980 survey assessed salt intake through urinary sodium concentration and found mean levels were higher in urban groups compared with their rural counterparts, and higher in Indians than in i-Taukei. Although public health interventions aimed at CVD risk factor reduction are being expanded across the entire Fijian population, additional interventions targeting high-risk population groups may be necessary [2]. In Fiji, the Ministry of Health, supported by WHO, is working closely with the food industry to reduce salt in frequently consumed processed foods [8].

Similarly, over the past three decades several surveys measuring blood pressure (BP) have been conducted in Samoa, with varied methodologies and definitions of hypertension [9]. "The Samoa Ministry of Health has highlighted that it is imperative to identify the impact or outcome of the NCD interventions that have been implemented in Samoa; however, nationally representative period trends in hypertension from multiple comparable cross-sectional surveys over several decades have not previously been estimated" [9]. Over the past 23 years, Samoa has established prevention and control interventions to aid the reduction of hypertension. This included the Healthy Islands Health Promotion Project initiated in 1995 which identified hypertension, diabetes and respiratory problems as a priority focus for health promotion in Samoa [9]. "Findings from a 2018 study indicated that preventive approaches relating to obesity from energy intake and inadequate physical activity, reduction in salt intake, and identification and treatment of cases of hypertension in the Samoan population need to be strengthened since decreases in hypertension prevalence was not yet evident. Rather, trends demonstrate a continued increase over the last 23 years" [9]. Similar to the trend in Fiji, the 2018 study in Samoa also indicated that the most affected population group in Samoa are men [9]. Although public health interventions aimed at CVD risk factor reduction are being expanded across the entire Samoan population, additional interventions targeting high-risk population groups, particularly men, may be necessary [9].

When it comes to treating hypertension, it is essential to calculate a patient’s absolute cardiovascular risk. "The components of this calculator are age, gender, smoking status, history of diabetes, total cholesterol level, HDL cholesterol (good cholesterol) and systolic BP. If a person is classified as low risk – <10 % , lifestyle changes should be implemented, which include a healthy diet, exercise, salt reduction, weight loss and if the BP remains consistently elevated >160/110 (high risk), antihypertensive medication needs to be commenced" [10].

First step in controlling the escalating rates of high blood pressure in the Pacific countries is to create awareness of the issue, change behaviour and implement measures to improve the food environment. This includes implementation of voluntary and regulatory policy measures such as food standards, labelling, price incentives and marketing controls.

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