Hypertension is the leading cause of cardiovascular and kidney diseases and over 1.5 billion are expected to be affected by hypertension by 2025 and this is especially adverse in South Asia given that the prevalence of hypertension is already at 40 percent. A policy forum held today on Hypertension and Cardio-Metabolic Diseases in Colombo will see government ministers, policymakers, economists, researchers and representatives of global health agencies address steps to prevent, pre-empt and treat hypertension and related co-morbidities, including diabetes, cardiovascular and kidney disease.

The half-day forum, co-organised by the multi-country Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) Study Group from Duke-NUS Medical School, Singapore, and the Clinical Trials Unit of the University of Kelaniya, Sri Lanka, was officiated by Dr. Harsha de Silva, State Minister for National Policies & Economic Affairs, Government of Sri Lanka, and included presentations and panel discussions involving Ministers of Health from the study countries in addition to key stakeholders from the research, academic and health sectors.

Prof. Tazeen Jafar, from Duke-NUS’ Health Services & Systems Research Signature Research Programme and overall lead investigator of the multi-country COBRA-BPS study, co-hosted the Forum and shared, “Up to three out of four adults with hypertension in South Asia have poorly controlled blood pressure, and one-third have co-existing diabetes. This is very concerning as complications, including heart attack, stroke, and kidney disease, tend to manifest 5-7 years earlier in South Asians than in Caucasian European populations. The COBRA-BPS study is evaluating novel, low-cost solutions for hypertension control and cardiovascular risk reduction in primary healthcare systems in rural communities in South Asia.

Prof. Jafar added “The recently launched SingHealth-Duke-NUS Global Health Institute in Singapore offers an excellent partnership opportunity for stewardship of a regional scale-up of COBRA-BPS strategies in South Asia, and to extend the same benefit to many Southeast Asian countries and beyond.”

Funded by the UK Medical Research Council (MRC), Wellcome Trust, Department for International Development (DFID), National Institute for Health Research (NIHR), and the UK Government’s Global Challenges Research Fund (GCRF), the COBRA-BPS study is led by Prof. Tazeen Jafar and her team at Duke-NUS Medical School, with data management and statistical analysis supported by the Singapore Clinical Research Institute (SCRI), in partnership with Dr. Aliya Naheed from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dr. Imtiaz Jehan from Aga Khan University, Pakistan, and Prof. Asita de Silva from the University of Kelaniya, Sri Lanka.

“This grant is of major importance in the global effort to address the rising burden of non-communicable diseases [NCDs],” stated Jill Jones, UK MRC Head of Global Health Strategy. “There is an urgent need for evidence on what works, to identify unmet needs and scalable solutions in the study countries to control hypertension and reduce NCD risk/prevalence. This study is a vital part of meeting that need."

Dr. Sania Nishtar, co-chair, WHO Independent Commission on the UN High-Level Meeting on Prevention and Control of NCDs, underscored the need for universal health coverage to include hypertension and diabetes care for all segments of the population, stating: “Countries are crying out desperately for help. This is evidenced by data from WHO’s Country Cooperation Strategies in more than 150 countries. We could end up undermining the economic viability of Universal Health Coverage if plans failed to address the world’s leading killer.”

Prof. Joep Perk, from the School of Health & Caring Sciences, Linnaeus University highlighted that the European Hypertension Guidelines, recently published at the 2018 meeting of the European Society of Cardiology in Munich, includes the recommendation to initiate treatment of hypertension with a combination of at least two blood pressure lowering drugs. He remarked, “The availability and access to effective and low-cost drugs, including combinations in one single tablet, may well contribute to an improvement of adherence to treatment, which so far has been a major concern. This will have significant impact for the large number of hypertensive patients in rural parts of South Asia, where satisfactory access to drug treatment remains a considerable challenge.”

Prof. Perk, Ms. Jones, Prof. Kate Hunt from the University of Glasgow, UK, Prof. Shah Ebrahim from London School of Hygiene & Tropical Medicine, UK, and Dr. Richard Smith, Chair of the ICDDR,B Board of Trustees and a former editor of the British Medical Journal, moderated the sessions and panel discussions. Dr. Shanthi Mendis, a former WHO adviser on NCDs, Prof. Jafar and Prof. Eric Finkelstein from Duke-NUS, Mr. Mihir Gandhi from SCRI, and representatives from academia, professional societies, the health ministries of Bangladesh and Pakistan, and the Sri Lankan offices of WHO and the World Bank also spoke at the event.