INTRODUCTION

EPIDEMIOLOGY
Hypertension is a global public health issue and a major cause of morbidity and mortality,
reported to be responsible for almost 13% of all deaths and 3.7% of total disability-adjusted
life-years.1 The worldwide prevalence of hypertension in individuals aged 25 years was
estimated to be approximately 40% in 2008. 1This is equivalent to almost one billion people,
and is predicted to increase to over 1.5 billion people by 2025. 1, 2 The prevalence of
hypertension is similarly high across different Asian countries, ranging from 30% in the
Republic of Korea to 47% in Mongolia. 3 Prevalence also increases with advancing
age.4, 5, 6, 7, 8 For example, the prevalence in Chinese patients is 39% overall, 3 59.4% in patients
aged 60 years4 and 72.8% in those aged 75 years.6 With a rapidly aging population, the
prevalence of hypertension and related cardiovascular morbidity in Asian patients continues
to rise, placing a substantial and escalating social and economic burden on this region.8, 9, 10

The prevalence of essential hypertension is alarmingly increasing in Pakistani population

inspite of the demographics being of lower BMI and nutrition. In this review, the possible
factors responsible for this increase are identified by reviewing the population studies
conducted in Pakistan. The prevalence rate is about 3 - 4% in childhood and steeply rises near
the middle age. The factors peculiar to Pakistan were increased genetic susceptibility,
environmental factors such as gender, females gender, urbanization, obesity and sedentary
life styles particularly in middle age, cultural practices promoting sedentary life style in
female11.

1. WHO Global Health Observatory. Prevalence of raised blood pressure: situations and
trends.
.http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ ( acces
sed 10 June 2014).
2. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of
hypertension: a systematic review. J Hypertens. 2004;22:1119. [PubMed]

3. World Health Organization Prevalence of raised blood pressure, ages 25+,

2008.
.http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/blood_pressure_pr
evalence/atlas.html ( accessed 10 June 2014).

4. Sheng CS, Liu M, Kang YY, Wei FF, Zhang L, Li GL, Dong Q, Huang QF, Li Y,
Wang JG. Prevalence, awareness, treatment and control of hypertension in elderly
Chinese. Hypertens Res.2013;36:824828. [PubMed]
 5. Davarian S, Crimmins E, Takahashi A, Saito Y. Sociodemographic correlates of four
indices of blood pressure and hypertension among older persons in
Japan. Gerontology. 2013;59:392400.[PMC free article] [PubMed]

6. Li YC, Wang LM, Jiang Y, Li XY, Zhang M, Hu N. Prevalence of hypertension

among Chinese adults in 2010 Zhonghua Yu Fang Yi Xue Za Zhi 201246409
413.413[in Chinese]. [PubMed]

7. Gupta R, Sharma KK, Gupta A, Agrawal A, Mohan I, Gupta VP, Khedar RS, Guptha
S. Persistent high prevalence of cardiovascular risk factors in the urban middle class
in India: Jaipur Heart Watch-5.J Assoc Physicians India. 2012;60:1116. [PubMed]

8. Lee JH, Yang DH, Park HS, Cho Y, Jun JE, Park WH, Chun BY, Shin JY, Shin DH,
Lee KS, Kim KS, Kim KB, Kim YJ, Chae SC. Incidence of hypertension in Korea: 5-
year follow-up study. J Korean Med Sci. 2011;26:12861292. [PMC free
article] [PubMed]

9. Chiang CE, Wang TD, Li YH, Lin TH, Chien KL, Yeh HI, Shyu KG, Tsai WC, Chao
TH, Hwang JJ, Chiang FT, Chen JH. 2010 guidelines of the Taiwan Society of
Cardiology for the management of hypertension. J Formos Med
Assoc. 2010;109:740773. [PubMed]

10. Chung N, Baek S, Chen MF, Liau CS, Park CG, Park J, Saruta T, Shimamoto K, Wu
Z, Zhu J, Fujita T. Expert recommendations on the challenges of hypertension in
Asia. Int J Clin Pract. 2008;62:13061312. [PubMed]

11. Kalim Uddin Aziz. Evolution of Systemic Hypertension in Pakistani Population.

Journal of the College of Physicians and Surgeons Pakistan 2015, Vol. 25 (4): 286-
291

DEFINITION

Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a

diastolic blood pressure (DBP) of 90 mm Hg or more, or taking antihypertensive medication.i

Based on recommendations of the Seventh Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the
classification of BP for adults aged 18 years or older has been as follows ii
Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

Hypertension may be primary, which may develop as a result of environmental,

psychological stress, dietary factors (increased salt and decreased potassium or calcium
intake) or genetic causes, or secondary, which has multiple etiologies, including renal,
vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of
adult cases, and secondary hypertension accounts for 2-10% of cases.

i. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--
2012 update: a report from the American Heart Association. Circulation. 2012 Jan
3. 125(1):e2-e220.
ii. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al.
Seventh report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec.
42(6):1206-52.
iii. [Guideline] James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline
for the management of high blood pressure in adults: report from the panel
members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013
Dec 18.
iv. Wood S. JNC 8 at last! Guidelines ease up on BP thresholds, drug choices.
Heartwire. December 18, 2013.
i
Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American
Heart Association. Circulation. 2012 Jan 3. 125(1):e2-e220.
ii
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec.
42(6):1206-52.

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC VI) defined and classified hypertension in adults, as shown
in Table 1.3 The diagnosis of hypertension is made when the average of 2 or more diastolic BP
measurements on at least 2 subsequent visits is 90 mm Hg or when the average of multiple systolic
BP readings on 2 or more subsequent visits is consistently 140 mm Hg.

3. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (JNC VI). Arch Intern Med. 1997;157:24132446.