The hypertensive Caribbean

ABSTRACT

Caribbean populations demonstrate a dramatic epidemiological transition, with cardiovascular disease the most common cause of death and hypertension the leading risk factor. Epidemiological surveys in the 1980s in Barbados and Trinidad found prevalence rates of 42 percent and 25 percent in population over 40 years and 35 years old, respectively, using the WHO criterion of blood pressure (BP) > 160/95. In a strictly standardised seven country survey carried out in 1992 and 1993 (ICSHIB) prevalence rates (BP>160/95) in the over 25 year old population of Barbados, Jamaica and St. Lucia were 21.5 percent, 17.5 percent and 18.3 percent, respectively, but 50 percent higher for BP>140/90. The gradient correlated closely with body mass index and with economic development and gross national product. In this study, rates of awareness, treatment and control were also highest in Barbados (90 percent, 85 percent, and 72 percent) and lowest in St. Lucia (74 percent, 59 percent and 35 percent). At the 140/90 level these figures were much lower, e.g. 75 percent, 66 percent and 38 percent in Barbados control was lower still, with only 18 percent having a most recent recorded blood pressure of <140/90. Part of the discrepancy may reflect the recognised higher value of "office" versus "home" BP recordings, and a "white coat effect". Nevertheless all studies indicate that the great majority of hypertensives in the Caribbean are not having their blood pressure controlled, with ominous implications for morbidity and mortality in the coming decades. Drugs used in primary care in Barbados conform to current (JNC VI, 1997) recommendations, i.e., frequency of use thiazide, beta blocker, angiotensin converting enzyme inhibitor and calcium channel blocker, but dietary approaches were documented in only one-third of patients. Greater effort needs to be placed on non-drug therapeutic approaches, and innovative mechanisms need to be developed urgently to achieve this, along with appropriate Caribbean strategies for low cost drug regimens. The Commonwealth Caribbean Medical Research Council has prepared, with wide consultation, regional guidelines for hypertension management.(AU)