Dealing with the burden of hypertension in Nepal: current status, challenges and health system issues

Hypertension is one of the risk factors for cardiovascular diseases, which form the bulk of noncommunicable diseases (NCDs). Studies done in Nepal have reported a prevalence of hypertension ranging from 18.8% to 41.8%. One study reported a tripling of prevalence from 1981 to 2006 in the same community. Along with hypertension, the prevalence of other cardiovascular risk factors has also increased. Nepal’s health-care system is unprepared to deal with these changes in disease burden, from tackling communicable, maternal and child health issues to NCDs. Out-of-pocket spending accounts for 55% of health-care spending in Nepal. Poor people are thus most vulnerable to the burden of hypertension and other NCDs due to their inability to afford the long-term treatment needed. Rapid enactment of an integrated national NCD policy, and effective prevention and control of hypertension is thus urgently required. This demands appropriate training and mobilization of the health workforce, including community-based health volunteers. Other measures include improving access to health care and essential medications, building institutional capacity to care for patients with hypertension, promoting lifestyle changes through community engagement, and introducing innovative policies to ensure the financial sustainability of these changes. Development of an equity-oriented, robust, people-responsive health system is critical in addressing this serious public health challenge. Noncommunicable diseases, hypertension and the regional context Worldwide, noncommunicable diseases (NCDs) surpass communicable diseases as causes of death. NCDs such as cardiovascular diseases (CVDs), cancers, chronic respiratory illnesses and diabetes account for more deaths than communicable illnesses such as diarrhoea, HIV, tuberculosis, childhood infections or malaria, and maternal, perinatal or nutritional conditions. Nearly two thirds of the 57 million deaths globally in 2008 were due to NCDs. Furthermore, nearly 80% of these deaths occurred in lowand middle-income countries, imposing a massive challenge to the already struggling health-care systems in these countries. NCDs also negatively impact the socioeconomic status and progress of these countries, as the population most affected is younger than 60 years of age. While poverty influences vulnerability to NCDs, access to care and outcomes of interventions, NCDs have a strong potential to increase individual and family impoverishment due to the need for long-term treatment and high out-of-pocket spending. Fortunately, many of the risk factors for NCDs are modifiable. Tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol are risk factors that are strongly associated with the development of NCDs. These behavioural risk factors increase the chances of developing i Assistant Professor in Medicine and Biochemistry, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal ii Professor of Medicine and Medical Education, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal