HYPERTENSION

Hypertension is a very serious public health problem in China. The increased incidence of this public health problem has been brought about by changes in diet and lifestyle, and therefore its prevention not only requires medication but also awareness (Ueshima, 2000). Excessive salt intake and reduced potassium intake has been found to be the major cause of hypertension. 266 million Chinese are estimated to be suffering from hypertension, 24 percent of people who are 15 years and above have been diagnosed with this problem. More than 40% of the Chinese people with hypertension are not aware of their condition (Gao et al., 2013). About 50% of the people diagnosed with hypertension are under medication for it whereas about 80% are not controlling their conditions well (WHO, 2010). This condition is the main risk factor for heart failure, stroke, heart attack and other arterial diseases. Generally, the pooled hypertension prevalence was 21.5% (about one out five Chinese. The subgroup analysis showed that the north had 25.8%, whereas the south had 20.4%with the condition. The male were 22.2% whereas for the female it was 19.9%. In large cities, the proportion was 18.9%, in medium cities it was found to be 24.6% whereas in small cities it was found to be 20.6% (Parati et al., 2014). If the risks will be properly reduced and prevented, it will reduce the need for prevention strategies that are medication-based in the future.

How to solve hypertension

            In China, stroke which is majorly caused by hypertension is considered to be the most deadly disease and it causes more frequent deaths compared to the coronary artery disease. Therefore, a program known as Tianjin Project was developed to increase the potassium intake and reduce the salt intake in order to prevent the cardiovascular disease. This program was majorly directed to the reduction of the risk factors for blood pressure that which is the major cause of stroke. This program was actively developed and the Health departments are implementing it (Reynolds, 2003). This program involves the development of a national strategy to control and prevent hypertension in china. In addition, it involves guaranteeing of funds for the management and prevention of hypertension in the country. Moreover, it aims to implement and popularize the guidelines that have been set in China for the management of hypertension (Xu, et al., 2010).

Furthermore, the government has recognized the importance of fighting hypertension and is now giving out funds for the implementation of this program. The principles that are being used are providing health education to parents and children; advocating correct diets, dietary interventions, encouraging food industries to produce foods with low fat and salt content. Additionally, the government is encouraging people to change their eating patterns and adopt vegetarian diets. lastly, encouraging the production and eating of fresh vegetables and fruits, and promotion of regular physical activities by providing the facilities that will enhance these activities (Gao, et al., 2013).

            Moreover, on top of the above given prevention measures of reducing the risk factors, high blood pressure should be detected early by use of the routine measurement at any time a patient or a person visits a health Centre. Thus, if diagnosed with the condition, the patient should implement the therapy with the use antihypertensive cost effective drugs. In addition to the implementation of the recommended strategies, this program also focuses on the need of carrying out research into the causes of vascular diseases and hypertension and the best procedures that healthcare professionals and the general population should receive the program. This program mainly emphasizes on the benefits of the multivariate approach to this condition (WHO, 2010). From the World Health Organization report, the traditional medical models for treating hypertension are not feasible since there is shortage of qualified trained personnel and the challenge the high costs (Zeng et al., 2011). It advocates that the approaches should be aimed at the problem by strategy based on the prevention of population and should target individuals who face the highest risk. The population measures that are supposed to be put into consideration are prevention or reduction of tobacco use, promotion of healthy diet and physical activities (Wang & Xiong, 2013).

            In Japan, a program has been implemented to lower the amount of salt intake. This program constitutes education programs targeted at the public through mass media, mass screening and health education. Also food labeling by manufacturers has been put in place. This program has made it possible to salt intake by about 50%, 12g/d. Systolic blood pressure has also dropped in the people aged 69 years and below by 18mmHg in both males and females. Over the period, the rate of stroke has dropped by 83%. The education program has been vital since it has enabled people and the community to comply with the proposed recommendations. Also, fresh food delivery has been enhanced through the improvement of road transport and delivery of freezer foods. Refrigeration has also promoted better eating habits by enabling eating of fresh foods. The implementation of low salt alternatives in restaurants and workplaces has also been vital. This program majorly focuses on the collaborative approach and the benefits that come with the supply of recommended foods with less or no extra costs after the public education to allow them to easily implement the proposed recommendations (Morgan, 2008).

Hypertension in future

            It is not easy to project the direction that China will take in the future as far as hypertension is concerned. However, proper measures for combating the issue need to be developed to improve the state of the society. There is a strategic approach to the guidelines which has been put in place to help prevent and decrease hypertension in the future. These guidelines are found in the JNC 8 guidance document. The approaches have also been discussed and proposed in China. Every individual is required to measure his or her blood pressure at least once annually. This is because hypertension can be diagnosed in a span of one year and be treated effectively and in a timely manner. In addition, there will be evaluation of the uncontrolled patients using ambulatory blood pressure monitoring in order to identify the people whose hypertension is uncontrolled (Parati et al., 2014).

Moreover, advanced imaging and non-imaging techniques that are used to detect the damage of the target organ and the arterial lesions will be employed. Applying these evaluations will provide evidence to back up the compelling signs and aid in the proper treatment and interventions of the condition. More so, in this evaluation process, some patients are likely to show the characteristics suggesting secondary hypertension and hence there will be a need for them to undergo the on-target screening for the secondary causes of hypertension. The proportion of individuals diagnosed with secondary hypertension may not be high. However, because of the increasing number of patients with hypertension, it may result in an increased number of patients suffering from secondary hypertension in China (Gee et al., 2014).

            Hypertension should be classified in accordance to its severity, blood pressure level, and pathophysiology or pathogenesis for its management. The main focus of the antihypertensive therapy should be to treat blood pressure to the target level. In situations where hypertension is uncontrolled, the severity of the disease should be evaluated by taking the measure and the structure of the vascular system and the organs that are targeted. For this reason, specific treatments should be put into consideration (Li & Ge, 2014). The only patients that should undergo the screening for the secondary causes of the hypertension are those who have shown the characteristics that suggest secondary hypertension or the specific pathophysiology or pathogenesis. Since eastern Asia has almost similar characteristics of hypertension, they should therefore come together, join hands and jointly fight against hypertension in the region. This is because there are possible common discussions concerning the guidelines of the disease in Asia. Moreover, the initiative of the pulse journal can also be as a kickoff of this process (Shimamoto et al., 2014).

            In japan, surveys that have been carried out in its population show that there is a clear decreasing tendency in the mean of systolic blood pressure in all the age groups including men and women. The disease is prevalent among the old people and is highly likely to increase in the future especially for the ages above 50 years. Despite the fact that the treatment of this condition has been high in the country, there has been a continuous improvement. To overcome hypertension, the first priority to be taken by Japan is to prevent lifetime increase of blood pressure by improving the lifestyle of individuals. For this goal to be achieved the distribution of blood pressure should be lowered in the whole population by ensuring it is distributed with a mean of 85mm and standard deviation of 20mm. Also the blood pressure should be maintained at the optimal levels by avoiding stress, smoking, cold temperatures caffeine and taking part in exercises (Miura et al., 2013).

            In my opinion, fighting this epidemic requires a collective effort of the government, and all the affected stakeholders. People should take responsibility and make sure that their blood pressure levels are checked and if diagnosed with the disease, they should control their condition. Most importantly, the public should be educated on the healthy living standards by encouraging them to participate in physical activities, providing the physical amenities to the people. Lastly, the population should be encouraged on healthy eating habits, taking foods with less salt, fats and taking vegetables.

References

Gao, Y., Chen, G., Tian, H., Lin, L., Lu, J., Weng, J., Jia, W., … China National Diabetes and Metabolic Disorders Study Group. (January 01, 2013). Prevalence of hypertension in china: a cross-sectional study. Plos One, 8, 6.)

Gee, M. E., Campbell, N., Sarrafzadegan, N., Jafar, T., Khalsa, T. K., Mangat, B., Poulter, N., … Zhang, X.-H. (November 01, 2014). Standards for the Uniform Reporting of Hypertension in Adults Using Population Survey Data: Recommendations From the World Hypertension League Expert Committee. The Journal of Clinical Hypertension, 16, 11, 773-781.

Li, H., & Ge, J. (March 01, 2015). Cardiovascular diseases in China: Current status and future perspectives. Ijc Heart & Vasculature, 6, 2, 25-31.

Miura, K., Nagai, M., & Ohkubo, T. (January 01, 2013). Epidemiology of hypertension in Japan: where are we now?. Circulation Journal : Official Journal of the Japanese Circulation Society, 77, 9, 2226-31.

Morgan, T. (September 01, 2008). Hypertension in the Asian Pacific region: the problem and the solution. Journal of Hypertension, 26, 9, 1883-1885.

Parati, G., Stergiou, G., O’Brien, E., Asmar, R., Beilin, L., Bilo, G., Clement, D., … European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. (January 01, 2014). European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. Journal of Hypertension, 32, 7, 1359-66.

Reynolds, K., Gu, D., Muntner, P., Wu, X., Chen, J., Huang, G., Duan, X., … InterASIA Collaborative Group. (January 01, 2003). Geographic variations in the prevalence, awareness, treatment and control of hypertension in China. Journal of Hypertension, 21, 7, 1273-81.

Shimamoto, K., Ando, K., Fujita, T., Hasebe, N., Higaki, J., Horiuchi, M., Imai, Y., … Japanese Society of Hypertension Committee for Guidelines for the Management of Hypertension. (January 01, 2014). The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertension Research : Official Journal of the Japanese Society of Hypertension, 37, 4, 253-390.

Ueshima, H., Zhang, X.-H., & Choudhury, S. R. (January 01, 2000). Epidemiology of hypertension in China and Japan. Journal of Human Hypertension, 14, 765-769.

Wang, J., & Xiong, X. (January 01, 2013). Evidence-Based Chinese Medicine for Hypertension. Evidence-based Complementary and Alternative Medicine, 2013, 2, 1-12.

WHO (Geneva). (2010). The world health report 2010: Health systems financing : the path to universal coverage. Geneva: World health organization (WHO.

Xu, T., Wang, Y., Li, W., Chen, W.-W., Zhu, M., Hu, B., Chen, T., … Liu, B. (June 01, 2010). Survey of Prevalence, Awareness, Treatment, and Control of Hypertension Among Chinese Governmental and Institutional Employees in Beijing. Clinical Cardiology, 33, 6.)

Zeng, Y., Du, J., Pu, X., Yang, S., Yang, T., & Jia, P. (October 30, 2011). Strategies of functional food for hypertension prevention in China. Journal of Medicinal Plant Research, 5, 24, 5671-5676.

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