Hypertension

Every morning, Prof. P.C. Joshi (former acting Vice-chancellor of Delhi University and currently president of SIMA President, Society for Indian Medical Anthropology) discerns in few sentences relevance of a particular date being celebrated as a special occasion to remind us of its historical, cultural, or contemporary relevance. 17th May is celebrated as World Hypertension Day.

World Hypertension Day WHD) was inaugurated in May 2005.

On this occasion Prof. Joshi wrote:

My Greetings on World Hypertension Day. Hypertension is also known as silent killer leading to heart attack and stroke if remained untreated. An estimated 1.13 billion people are suffering with hypertension and unfortunately most of them are from lower- and middle-income groups/ communities. It is important that people are made aware of this hidden evil. As diagnosis of hypertension is not very complicated, schools and colleges should be involved in identification of its occurrence in economically backward areas. It's risk factors like excess salt intake, trans-fats, lack of exercise require regular monitoring and healthy practices to be encouraged. Let's not forget that Hypertension is a cause of concern for one in four males and one in five females. Let's minimise the risk of Hypertension by early detection and lifestyle including dietary modification in time and thereby save precious human lives.

Hypertension as stated is a silent killer and lack of awareness among the poorest of the poor and those with low literacy levels is a serious concern not only in India but across the globe. Anthropologists for decades are studying biological, cultural, and cognitive factors responsible for fluctuations in systolic (low blood pressure) and diastolic (high blood pressure) and its linkages at community level. Several scholars are also exploring Hypertension in an anthropological and evolutionary paradigm (Robert S. Danziger, 2001). It was thus natural that the posting received several responses from members of the UIAF.

Responding to these concerns Dr. Bhagwan Roy (Chairman, IBRAD) wrote:

Discussion on this important yet invisible problem is critical. As medical anthropologists, we have lots of responsibility. You have listed important factors such as lifestyle related issues of food, exercise etc. These are factors of Bio-Social processes, a subject matter of Medical Anthropology.Recent study and experiments by many experts have demonstrated that the problem of Blood Pressure can be reversed by changing the lifestyle. I have experienced and got benefitted. I have been on medication for both diabetes and Hypertension. My dependence on multiple pills is now considerably reduced as I manage my lifestyle much better. My sugar levels and BP parameters are in the normal range now. I will stop all the pills by next month. The purpose of sharing this personal experience is to provide evidence of what you are advocating about the lifestyle is well established. Dr. Lalit Mohan-a well-known nutrition expert from USA, has made significant contributions in this regard. To be more specific it is more of Bio-cultural practices. We Anthropologist study culture. Habits are culturally acquired traits. These are determined by Knowledge, belief, and morals. Changing lifestyle must become a habit. Knowledge alone is not enough, to ensure requisite lifestyle changes. These must be internalized for the knowledge to become action.

Responding to these concerns, and to issues raised by Dr. Bhagwan Roy; Prof. Saraswati, Department of Anthropology, University of Delhi observed:

Thank you very much sir for initiating a dialogue on Hypertension.

As everyone is aware, hypertension is one of the biggest public health concerns. Some understand hypertension as a variable, some as a condition, some as a disease, and yet others as a risk factor for various cardiovascular disorders. Criteria for diagnosis of hypertension in terms of systolic and diastolic blood pressure have changed over time and have progressively become more stringent. With these new guidelines, increasingly, more people have come into the bracket of hypertension. Possible reasons behind the strict criteria for hypertension can be to make the medical fraternity as well as common people more cautious about hypertension, however benefiting pharmaceutical companies can also be a factor.

Initially, hypertension was thought to be driven by metabolic pathways, however recent studies have attributed it to neurological pathways as well. Both metabolic, as well as neurological factors, are influenced by undernutrition (in terms of micronutrient deficiencies) as well as overnutrition (in terms of fatty acid accumulation). As per the experience of Bhagwan sir, high blood pressure and high glucose levels can be reversed through lifestyle changes. Here, I would like to bring in epigenetic forces which start with cell differentiation in the embryo and continue throughout life. These epigenetic forces, however, are influenced by various factors like age, sex, nutrition physical activity, etc., and are reversible in nature. This discussion not only underpins the fact that hypertension has a complex etiology, but also brings forth the notion that intervention models for hypertension need not always be medical/pharmaceutical. In one of our studies on hypertension, we found that drugs for hypertension act by altering epigenetic signatures (global DNS methylation). Hypertension has always been looked at either through the medical lens whereby medication is thought to be the suitable intervention or through the social lens in terms of socioeconomic condition, educational status, etc. However, this sectoral approach may not be the right approach to understanding a complex trait like hypertension. Biosocial traits are determined by culture and vice versa. Community-specific values, morals, and knowledge, as mentioned by Prof. B.S. Roy, are equally important in epigenetics. Therefore, to understand, manage and treat hypertension, a holistic anthropological view is much more appropriate, especially in countries like India where diversity is at its peak. There is a dire need for an anthropological model, which incorporates bio-social and cultural perspectives, to understand hypertension.

I am happy to share that, my team is currently doing fieldwork for a project sponsored by ICMR in Punjab, whereby we are trying to understand the epigenetics underlying the etiology as well as the management of hypertension.

Prof. S R Mondal (former professor of Anthropology and Himalayan Studies, North Bengal University) added,

Contemporary sedentary lifestyle and co-related occupations as well as occupational stress, is very much responsible in the rapid increase of these cases. Along with that broken family relationship and kinship bondage, are creating a lot of mental stress on everyone. This is also another crucial factor. Along with the biological factors, these social factors are to be addressed too, to minimize this risk in the coming days.

Another query posed:

Just a curiosity. I am not an expert in this field. But yours and other messages enabled me to think on it. There is also a need to study hypertension in historical retrospect along with its other dimensions. Is it changing over times under changing environmental and socio- cultural contexts, particularly of recent times? We need to know the---GENEALOGY OF HYPERTENSION.

KNOWN FACTS ABOUT HYPERTENSION/BLOOD PRESSURE IN INDIA

Overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7–33.0). Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2–32.0) and 33.8% (29.7–37.8); P = 0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3–15.7), 31.7% (30.2–33.3), 18.1% (16.9–19.2), and 21.1% (20.1–22.0) for rural north, east, west, and south India; and 28.8% (26.9–30.8), 34.5% (32.6–36.5), 35.8% (35.2–36.5), and 31.8% (30.4–33.1) for urban north, east, west, and south India, respectively. Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4–29.3), 25.1% (17.0–33.1), and 10.7% (6.5–15.0) for rural Indians; and 42.0% (35.2–48.9), 37.6% (24.0–51.2), and 20.2% (11.6–28.7) for urban Indians.

INFERENCE

About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.

(Cf. Anchala, R., Kannuri, N. K., Pant, H., Khan, H., Franco, O. H., Di Angelantonio, E., & Prabhakaran, D. (2014). Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. Journal of hypertension, 32(6), 1170–1177 https://doi.org/10.1097/HJH.0000000000000146

(source: Adityabirlacapital.com)

This conversation must continue and other colleagues and visitors to the website are invited to share their empirical, academic and research experiences and generate a public discourse and awareness. Theory of innovation is rooted in the belief that “new knowledge comes about when practitioners seek to turn an unreflective practice into a reflexive social interaction” (Tsoukas,2003). Friends, let us join hands and enhance this process of knowledge sharing.

Reference:

Tsoukas (2003) (3) (PDF) A Dialogical Approach to the Creation of New Knowledge in Organizations. Available from: https://www.researchgate.net/publication/220521035_A_Dialogical_Approach_to_the_Creation_of_New_Knowledge_in_Organizations[accessed May 21 2022].

Editorial inputs:

Shalina Mehta

Professor of Social and Cultural anthropology ( retd)

Shalinamehta137@gmail.com