Study on rising burden of hypertension in Bangladesh

Background: Bangladesh is experiencing epidemiological transition, having a rise in chronic non-communicable diseases. Cardiovascular diseases, mostly hypertension, exert a huge burden in developing world, and the related economic cost is enormous for low-income countries. The situation in Bangladesh would not differ, however, the burden is yet to be quantified. This thesis aims to measure the burden and identify the avenue to take actions accordingly. The research findings presented in this thesis addressed the following areas: who is diagnosing hypertension in Bangladesh, burden of prehypertension, and undiagnosed & uncontrolled hypertension in Bangladesh, level of adherence to antihypertensive treatment in Bangladesh, and the associated factors. Key findings: Over 70% people live in rural areas of Bangladesh. Unqualified providers play a major role in diagnosing and managing hypertension in the rural areas. Over one fourth of the hypertensive people are non-adherent to antihypertensive treatment. One third of the population are identified as pre-hypertensive. Finally 11% of the people reported having no hypertension are found to be hypertensive, a huge underlying problem of undiagnosed or unawareness of the situation. Over 50% of the people receiving antihypertensive treatment had uncontrolled hypertension. Women, elderly, young men, poorest people are likely to be more affected. Conclusion and recommendation: Our findings showed that hypertension is a public health problem in Bangladesh, both because of high prevalence and the low rates of control. Greater attention for actions to prevent CVD and other chronic diseases in this setting is required. Population wide interventions to promote healthy lifestyle will shift the prevalence to lower levels. Individual high-risk approach is also feasible when treatment decisions are based on the risk of the disease, rather than on the level of a single risk factor blood pressure. Low-level providers should be utilized after proper training; and m-health and e-health method of intervention provides another option.