Nearly a quarter of men and one-fifth of women in India have hypertension that increases the risk of cardiovascular, kidney disease and premature death, according to NFHS 5 data .

In women, along with the factors like high salt and fat intake, sedentary lifestyle, genetics, chronic conditions such as kidney disease, diabetes, high cholesterol level and obesity, aging and hormonal imbalance, prolonged use of oral contraceptive pills, pregnancy and menopause all play an active role in the manifestation of the condition. Besides, they experience stress from their jobs as over the years their position in the family has gradually changed from bread-maker to breadwinner.

In women, the types of hypertension that may manifest before or during pregnancy are chronic hypertension, gestational hypertension, pre-eclampsia or eclampsia. The older a woman gets, she is more likely to develop hypertension and the associated cardiovascular disease. `

It is to be noted that women with chronic hypertension are at risk of experiencing serious complications during pregnancy. There is always a chance that 510% of pregnancies will become complicated by hypertension, and rates are likely to rise if the patient is obese. Women who have chronic hypertension can also get preeclampsia in the second or third trimester of pregnancy. However, hypertension in pregnancy does not occur exclusively and it is imperative to diagnose pre-existing cases, which either precedes pregnancy or develop before 20 weeks of gestation and generally lingers beyond 42 days, i.e.; after the postpartum period.

Occasionally, chronic hypertension may be superimposed by preeclampsia. Such high blood pressure can be dangerous for both the child and mother. In rare cases, symptoms may not start until after delivery.

Gestational hypertension can develop into preeclampsia

Preeclampsia is a hypertensive disorder that can occur during pregnancy stressing the heart and other organs, and can cause serious complications like proteinuria, derailing the blood supply to the placenta, impairing liver and kidney function and fluid build-up in the lungs. Whilst, Eclampsia is a severe complication of Preeclampsia- a rare but serious condition where high blood pressure results in seizures during pregnancy.

Therefore, careful monitoring of blood pressure in a pregnant woman by a medical practitioner before, during and after pregnancy is essential as it tends to exist silently in the body.

Taking the stalk of the situation, the government launched the Newborn Action Plan (INAP) in June 2014 which aspires to bring neonatal mortality to a single digit by 2030 by providing continuum care for neonatal survival starting from preconception and continuing up to postpartum care. Pre-conceptional care requires blood pressure monitoring for every woman who is planning to get pregnant by a medical practitioner and also charting the blood pressure during and after pregnancy. Even the National health programmes work for adolescent health, safe motherhood and new born care.

In India, 25% of women who exhibit the tendency of mild high blood pressure during pregnancy continue to be hypertensive after childbirth and visiting the hospital twice or thrice during pregnancy may not be enough.

In addition, when a woman reaches the peri-menopausal and menopausal stage, she becomes prone to hypertension due to hormonal changes. Hence, it is essential to monitor blood pressure along with her other medical vitals, and if the readings are continually high, she should be put on medication.

To prevent pre-hypertension from progressing to full-blown hypertension, one should make lifestyle adjustments such as increasing physical activity, eating a low-fat, low-sodium diet, abstaining from smoking and drinking, and maintaining ideal body weight.

Since it has been observed that the majority of women are not socially or financially able to pay for the prescription or bring someone with them to the hospital, therapy should start with one pill and be adjusted as needed.

Sometimes, treatment compliance remains challenging for a woman as she is a working professional and visiting the nearest primary healthcare centre for a refill of her blood pressure medication becomes a humongous task for her and irregular access to anti-hypertensive medicines often leads to non-adherence to treatment and a fall-out.

In this case, The Ministry of Health and Family Welfares (MoHFW), Government of India (GoI) initiative at the start of the Covid in March 2020, proved to be fruitful. It wrote to all states and Union Territories (UTs) recommending making anti-hypertension drugs available for free and in sufficient quantities at all Ayushman Bharat Health and Wellness Centres (ABHWCs), at sub-centre and Primary Health Centres (PHCs). All known diagnosed patients with hypertension, diabetes, chronic obstructive pulmonary disease and mental health to receive a regular supply of medicines for up to 90 days through ASHAs or health sub-centres on prescription. This extended refill prescription approach for chronic diseases proved to be an innovative and sure-shot step towards ensuring the last-mile delivery of drugs and the continuation of such module can help go long way in tackling hypertension in women. Also, ASHAs and other health sub-centers should regularly check the blood pressure of women as it can help in the monitoring of female hypertension.

Most importantly, when a woman is told she has high blood pressure, its crucial that she follows through with the recommended treatment, medications, and check ups. It is essential to provide the patient with counselling and make clear to her the significance of adhering to her medication throughout her life, citing the risks of a stroke, damaged kidneys, damaged heart, and vision impairment.

Views expressed above are the author's own.

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Hypertension in women and the way forward - Times of India

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