Risk Factors of Hypertension in Low- and Middle-income Countries: A Prompt Portray

The World Health Organization (WHO) defined hypertension, correspondingly recognised as elevated or upraised blood pressure (BP), as an ailment in which the blood vessels have persistently raised pressure to 140/90 mmHg or grander.[1,2] The WHO appraised globally that 1.28 billion adults aged 30–79 years are suffering from hypertension, and the majority (two-thirds) of them breathe in low- and middle-income countries (LMICs).[2] Mills et al., in 2000, reported that the pervasiveness of high BP amongst adults was sky-high in LMICs (31.5%, 1.04 billion people) than in high-income countries (28.5%, 349 million people).[3] It has been reported that an estimated globally 8.5 million people died because of hypertension and related issues in 2015, and amongst these fatal cases, 88% of hypertension individuals are from LMICs.[4] The alarming issue is around 46% of hypertensive subjects are not cognizant that they have the disease.[2] Only 42% of hypertensive individuals are diagnosed and receive pharmacological intervention.[2] In addition, in recent years, an upper trend of primary hypertension has been observed in the paediatric age group, particularly in adolescents.[5-8] According to the American Heart Association, the overall prevalence of hypertension in children is 2%–5%, and obesity, along with lack of physical activity, is the dominant determinant for the development of hypertension,[9] and this may lead to end-organ damage like adults.[10] 'People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services'.[11] Cabieses and Bird reported mounting substantiation on ingress to healthcare in LMICs, which confesses unfairness in utilising public health management systems. These inequalities exist both amidst countries and within, with the most marginalised communities facing the maximum hurdles to the way in healthcare.[12] After that, humanising access to healthcare is currently considered a global issue.[13,14] Schutte et al., in 2021, reported that in recent times, hypertensive patients have been considerably raised in LMICs. In addition, only 33.33% of these hypertensive individuals are aware of their fatal disease, and approximately 8% have BP controlled with proper therapeutic intervention.[15] Essential hypertension is the topmost principal element of health menace for ischaemic heart disease, additional cardiovascular diseases (CVDs), cerebrovascular accident, chronic renal impairment, major neurocognitive disorder, mild cognitive disorder and neurological diseases.[16-21] Multiple studies reported that globally raised BP is a foremost avertable basis of CVD-related death and disease encumbrance.[3,22-24] The World Health Assembly in 2013 planned to reduce the prevalence of hypertension by 25% by 2025 from 2010.[3,25-27] Multiple elements raise the possibility of high BP [Figure 1].[28] Some of these features are adjustable,[29,30] and other probability aspects, for example, increasing age,[31] race and ethnicity,[32] ancestral tree,[33] transmitted heritable[34] and sex,[35-37] cannot be altered.[28] Lifestyle is a determined factor amongst modifiable risk issues of hypertension.[38] The National Institute for Health and Care Excellence identified four amendable lifestyle issues that increase the possibility of developing hypertension.[39] Those risk factors are 'regular aerobic exercise and reduction of salt, alcohol and smoking'.[39] Other studies reported that minimisation of overweight and obesity, consistent physical activity, control or restraint of alcohol drinking and implementation of dietary approaches to stop hypertension (DASH) style food regimen comprising restricted Na + salt consumption possess beneficial effects amongst hypertensive subjects.[40-42]Figure 1: The multiple elements that raise the possibility of high blood. This figure has been drawn with the premium version of BioRender (https://biorender.com/. Accessed on 12 April 2024) with agreement license number NY26OU012D. Image credit: Rahnuma Ahmad.Individuals gaining excess weight, especially visceral adiposity, are considered a substantial cause of hypertension. It has been reported that 65%–78% of essential hypertensive individuals are concurrently suffering from overweight or obesity (as weird or extreme fat accumulation).[43-45] Overweight and obesity are not strongly related, but also other cardiovascular,[46] chronic kidney diseases,[47,48] metabolic[49,50] and carcinoma[51] diseases have precipitously befitted a leading worldwide health risk.[52-54] Multiple studies conducted amongst diverse populations in almost every part of the globe reported that the association between body mass index (BMI) (>30 kg/m2) and high BP is virtually linear.[55-58] Mayo Clinic reported that routine physical activity also continues to help maintain beneficial weight management. Slimming down has been the well-known approach for hypertension. Even dropping 2.3 kilograms or 5 pounds takes down hypertension.[59,60] It has been advised to do 2½–5 h or 1¼–2½ h of moderate and vigorous aerobic activity per week.[61] One more study recommended that individuals distressed by high BP be motivated to be involved in aerobic physical activity in a routine practice, for example, swimming, jogging or walking, for at least 30–45 min per day.[62] Whichever physical action escalates, heart and respiratory rates are cogitated as an aerobic activity.[59,60] Hegde and Solomon, in 2015, reported that lifestyle issues such as diet and sedentary activity (deskbound job) are triggering factors to develop hypertension, causing considerable morbidity, mortality and global burden.[61] This study also showed that regular physical activity lowers hypertension, cardiovascular risk and cardiac remodelling.[63] Diet and physical activity are considered as modifiable risk factors.[64] Increased aerobic physical activity reduces peripheral arterial resistance, possibly because of neurohormonal and structural responses because decreased adrenergic activity increases the diameter of the arterial lumen.[65] Green et al., in 2017, reported that regular aerobic physical activity improves blood flow and cuts back peripheral vascular wall tension, luminal stress and arterial pressure.[66] These changes convert arterial diameter wall width and stiffness. After that, vascular physiology was restored, especially in the coronary and mesenteric arteries.[66,67] Aerobic physical activity inhibits reactive oxidative stress and pro-inflammatory signals. Consequently, the vascular inflammatory effect is curtailed.[68] Accordingly, it improves endothelial physiology,[69,70] parasympathetic activity[71] and renal function.[72] In addition, it reduces BMI,[73,74] renin–angiotensin system activity,[75,76] insulin resistance[76-79] and finally enhances arterial compliance [Figure 2].[80,81] Multiple studies advocated non-pharmacological strategies, a DASH diet and aerobic physical activity to manage hypertension.[82-86]Figure 2: The various mechanisms by which regular physical aerobic exercise aids in the reduction of blood pressure to normal. This figure has been drawn with the premium version of BioRender (https://biorender.com/. Accessed on 14 April 2024) with license number IT26P57 LH5. Image credit: Rahnuma Ahmad. ROS: Reactive oxygen species.Various research invariably shows implications between excessive alcohol drinking and the development of hypertension.[87,88] Nonetheless, the mode of action regarding alcohol-induced hypertension is still not well explained.[87] Alcohol increases adrenergic activity that, in the sequel, raises heart rate, cardiac output and both systolic and diastolic BP.[87,89,90] Minimisation of alcohol intake is the first strategy to control alcohol-induced high BP.[87,91,92] Increased aerobic physical activity is one of the most substantial non-pharmacological approaches to avert long-lasting alcohol-induced hypertension.[87,93,94] The high rate of mortality amongst hypertensive cases is because of cardiovascular events[95] and metabolic syndrome (MetS).[96] Raised BP is envisioned as an imperative constituent of MetS.[96-98] Over 85% of those with MetS, even in the non-existence of diabetes mellitus, have raised BP or hypertension.[99] Control of hypertension decreases the possibility of the development of MetS-associated morbidity and mortality.[100] Therefore, the management of hypertension should be controlled through pharmacological[101,102] intervention along with non-pharmacological strategies of equal importance.[82,103-105]Figure 3 illustrates the principal findings of this editorial.Figure 3: The critical findings of the study. This figure has been drawn with the premium version of BioRender (https://biorender.com/. Accessed on 12 April 2024) with license number XX26OTQZ2 L. Image credit: Rahnuma Ahmad. WHO: World Health Organization, LMICs: Low- and middle-income countries, BMI: Body mass index, CVD: Cardiovascular disease, CVA: Cerebrovascular accident, NICE: The National Institute for Health and Care Excellence, DASH: Dietary approaches to stop hypertension, ROS: Reactive oxygen species.Consent for publication The author reviewed and approved the final version and has agreed to be accountable for all aspects of the work, including any accuracy or integrity issues. Disclosure The author declares that they do not have any financial involvement or affiliations with any organisation, association or entity directly or indirectly related to the subject matter or materials presented in this article. This includes honoraria, expert testimony, employment, ownership of stocks or options, patents or grants received or pending royalties. Data availability Information for this editorial is taken from freely available sources. Authorship contribution All authors contributed significantly to the work, whether in the conception, design, utilisation, collection, analysis and interpretation of data or all these areas. They also participated in the article's drafting, revision or critical review, gave their final approval for the version that would be published, decided on the journal to which the article would be submitted and made the responsible decision to be held accountable for all aspects of the work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.