About 6.3 million South Africans have elevated blood pressure, or hypertension. This represents about a third of the adult population and is a major risk for heart disease and stroke, as well as kidney disease. Known as the ‘silent killer’ thissymptom-less disease is a leading cause of death in SA.
According to Professor Brian Rayner, head of the Southern Africa Hypertension Society, roughly half of the hypertensive population are not aware that they have raised blood pressure.
“One of the ways in which to improve the diagnosis of high blood pressure in South Africa through more accurate readings is to use ambulatory blood pressure monitoring (ABPM). This technique uses a cuff connected to a microchip that measures and records blood pressure levels at regular intervals during a 24 hour period. The small device takes measurements every 30 minutes day and night, during one’s normal routine,” says Rayner.
Rayner explains that sporadic blood pressure checks arE accurate as frequent readings taken throughout the day.
“About 20 percent of patients who are consistently hypertensive in their doctor’s office or clinic don’t have high blood pressure the rest of the day. This phenomenon, called ‘white coat hypertension’ reflects the anxiety often caused by a visit to the doctor. ABPM is an important diagnostic tool for detecting this. Data from ABPM devices show that although office readings routinely over diagnose hypertension, they sometimes under diagnose it. The flip side of white coat hypertension is called masked hypertension – office readings are normal, but those taken outside the office using ABPM are high. About 10 percent of people whose blood pressure appears normal in the office in fact have hypertension, and their disease goes undetected.”
Rayner says that despite the obvious advantages of ABPM, its use remains low in South Africa due to its associated costs. To address this need, Cipla Medpro, one of South Africa’s leading pharmaceutical companies has recently launched a national pharmacy based 24-hr ABPM service called BP Watch. The service, which will initially be offered through Dis-Chem clinics, will be expanded through independent pharmacies to broaden the footprint and make the service available to more doctors and their patients. Rayner says the United Kingdom (UK) recently introduced guidelines under the National Institute for Health and Care Excellence (NICE) stating that a diagnosis of primary hypertension should be confirmed using 24-hr ABPM.
Research that informed the guidelines found that implementation of a diagnostic strategy for hypertension using ambulatory monitoring would reduce misdiagnosis and be cost saving for the country’s National Health Service (NHS). “In South Africa we loosely follow international guidelines such as those prescribed by NICE so we are very encouraged by the recommendation of ABPM being included in the UK and hope that South Africa will follow suit. As the number of people affected by hypertension goes up, we do strongly encourage that doctors and patients consider 24-hour ABPM,” Rayner concludes.
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