Asian management of hypertension: Current status, home blood pressure, and specific concerns in Pakistan

Hypertension has reached epidemic proportions in Pakistan, and cardiovascular disease accounts for half of all non-communicable diseases in the country. Although home blood pressure monitoring (HBPM) is being used in Pakistan, it is not routine practice, and cost is a major barrier to uptake. Other barriers include a lack of awareness of the utility of HBPM among patients and physicians, low education literacy levels in the general population, variability of results obtained using HBPM due to the presence of a large number of non-validated monitors on the market, and a lack of awareness among physicians about the correct methodology for using HBPM. The Pakistan Hypertension League (PHL) does recommend use of a validated digital HBPM device for BP measurement. Recent data suggest that calcium channel blockers are the most commonly used antihypertensive agents, with ß-blockers and angiotensin receptor blockers also widely used. Traditional medicine remains popular in Pakistan because it is more accessible, especially in rural areas, and is less expensive than conventional antihypertensives. The growing burden of hypertension and cardiovascular disease in Pakistan is compounded by the poor socioeconomic status of a fairly large proportion of the population, and lack of literacy and education. There is also a shortage of adequately trained medical personnel to take care of the increasing number of patients. The PHL and Pakistan Cardiac Society are working to increase awareness of hypertension at both the population and government levels.