Letter to The Times on Hypertension Published on 20th September, 2013
The Editor Friday 13th September 2013
The Times
Dear Sir,
Our letter refers to the headline and the article published on the front page of ‘The Times’ on the 12 September. The statistician-general, Pali Lehohla, was reported as saying that deaths due to hypertension and stroke were more common in white South Africans compared to Blacks because hypertension is a disease of “not being happy”. This statement shows a total lack of understanding and insight into the massive burden of hypertension deaths in all people in our country, the risk factors related to hypertension and the origin of happiness in our people. The report is also misleading as the statistical reporting of the deaths is not correct.
It is also necessary to understand that hypertension (also called “high-high” by many in our country), is a condition associated with increasing age. The average age of black South Africans is substantially lower than whites, and therefore it is vitally important to age-standardise the mortality rate of hypertension. The data presented in your article has failed to apply this essential step of data analyses and has only reported the raw data. This is akin to comparing apples with oranges.
When this essential age-standardisation step is applied to the mortality data reported in 2009 to Statistics South Africa, a completely different picture emerges. This exercise was undertaken at the Medical Research Council. The adjusted data leaves no doubt deaths related to hypertension occurred most frequently in the African people in the country and least frequently in the white people.
To create the impression that the African people who have hypertension are at any lower risk of dying of hypertension than any other group in the country is truly irresponsible. Any person with hypertension can only be protected from the devastating effects of this condition if they are diagnosed early and adequately treated with medication to reduce their blood pressure to normal levels of BP ≤ 140/90 mmHg. In most surveys in the country measuring blood pressure it shows that about half the people with hypertension are unaware of having this dangerous condition that can be effectively treated. As the condition generally has no symptoms it is aptly named the “silent killer”. Therefore the best advice to give to all South Africans is to have their blood pressure measured regularly, and if elevated seek further advise from their local clinic or general practitioner and initiate blood pressure treatment if required.
The biggest risk factor for hypertension, that can be changed, is being overweight or obese. In South Africa over half the women of all groups fall in this category. People who have hypertension and are overweight or obese can benefit greatly be reducing their weight. Excessive salt intake, also a risk factor for hypertension, is extremely common. It has motivated South Africa’s Minister of Health to pass regulations to reduce salt in South African food in order to reduce the high rates of hypertension in the country. Excessive alcohol use equally contributes to high blood pressure. This is also receiving attention of our Minister of Health.
As for the association suggested in your article between high blood pressure and unhappiness, we are not aware of any well conducted study in South Africa that have identified such a relationship and we therefore reject this incorrect statement outright.
Prof Brian Rayner
President of the Hypertension Society of South Africa
Prof Krisela Steyn
Chronic Disease Initiative for Africa
And
The Hypertension Society of South Africa
