Challenges in Hypertension: The Haiti Experience

THE CRITICAL IMPACT OF HYPERTENSION IN HAITI The article in this issue of the Journal of Clinical Hypertension by John Kenerson describes very well the enormity of the problem of hypertension in Haiti. It touches on the social, cultural, and environmental aspects of this problem and underscores its public health dimension. The article can be considered as an overseas echo of the previous declaration expressed by us in a May 2013 article published in the oldest daily newspaper in Haiti, “Le Nouvelliste,” under the title “Le cri assourdissant mais ignor e de l’hypertension art erielle en Haiti” (The Deafening But Ignored Cry of Hypertension in Haiti). In July 2012, the Haiti Ministry of Health (MSPP) published a booklet, “Politique Nationale de Sant e,” describing the scope of health issues in Haiti. It defined clearly that hypertension is the greatest cause of morbidity and mortality in Haiti among adults, ahead of HIV, cholera, tuberculosis, and malaria combined. As pointed out by Dr Kenerson, the World Health Organization (WHO) describes Haiti as having a remarkably high prevalence and incidence of stroke or cerebrovascular accident: 176 of 100,000 as opposed to 82 of 100,000 in the Dominican Republic. Hypertension is the main risk factor for cardiac and renal diseases worldwide. In an ongoing heart failure research project at the Hopital Universitaire d’Etat d’Haiti (UEH), the main teaching hospital of the State University of Haiti, hypertension was identified as the primary cause of heart failure in 45% of patients and of peri-partum cardiomyopathy in 43%. These findings were reported in the “Journ ee acad emique du CHAMI” (Coll ege Haitien de M edecine Interne) in November 2012 and also at the 7th Annual Convention of the College Haitien de Cardiologie in May 2013 by Dr Rodolphe Malebranche, Physician in Chief of Internal Medicine at the Faculty of Medicine and Pharmacy School of Technology (FMP)-UEH, the State University Medical School established in 1818. In September 2012, we conducted a randomized survey of patients in the Internal Medicine Service at HUEH and found that of patients admitted for whatever reason (eg, abdominal pain, diarrhea, or anemia), 75% had hypertension as a concomitant diagnosis. Moreover, 80% of those patients had severe hypertension even though they were admitted for other reasons. Of great concern is the fact that the median age of those patients was only 43 years (Figure 1 and Figure 2).