The objective of this guideline is to provide clear and concise information to all health care providers on the current concepts in the management of hypertension. Since hypertension is managed by various levels of health care providers in Bangladesh, attempts were made to ensure that different stakeholders benefit from this guideline. Non-Communicable Diseases Control (NCDC) Program of Directorate General of Health Services (DGHS) has developed a treatment protocol for management of diabetes and hypertension at primary health care settings in October 2019. In the first revision of the National Guidelines for Management of Hypertension in Bangladesh, those treatment protocols and new evidence from different global guidelines has been incorporated to make these guidelines easily available and usable by secondary and tertiary level health care providers working in limited resource settings.
Chapter - 1: Introduction
exp date isn't null, but text field is
Hypertension or elevated blood pressure significantly increases the risk of disease of the heart, brain, kidney and other organs and it is the leading cause of death globally. About 1.4 billion people worldwide have high blood pressure1,2. Despite the availability of effective treatments for hypertension, blood pressure control rates are poor especially in Low middle income countries3. According to the Bangladesh Non-Communicable Disease (NCD) Risk Factor Survey 2022, percentage with hypertension in adults aged 18-69 years, is 23.5% in general, 24.1% in men and 23.0% in women4. The prevalence of hypertension among elderly people (>60 years) of Bangladesh is 49%, 42% among male, and 56% among females5. Almost 50% of hypertensive adults in Bangladesh are unaware about their condition and 35% of hypertensives are under treatment, while only 14% have their blood pressure under control 5,6,7.
In Bangladesh treatment of hypertension is mostly provided by general practitioners and specialist physicians including cardiologists through government and private health care facilities. In union level government facilities, medical assistants, and community health care providers at community clinics screen for high blood pressure and refer for diagnosis and treatment to physicians. However, many hypertensive patients receive treatment from village doctors8. Adherence to hypertension treatment is low mainly due to lack of understanding about necessity of continued treatment once blood pressure level become lower after taking medication and cost of medication in case of poor patients. Lack of updated information and current recommendations on hypertension management for physicians at primary care level are also a barrier for providing proper management. Although several guidelines for hypertension treatment by various international professional organizations are available9-13, a country specific guideline taking account of the context of Bangladeshi population is needed for effective management of hypertension by physicians and health care providers working at various tiers of health care system.
The National Guidelines for Management of Hypertension in Bangladesh was developed in 2013 by an expert committee of Directorate General of Health Services of Ministry of Health and Family Welfare, Government of Bangladesh14. Due to the global advancement in medicine, the guidelines need revision and updating in the light of new evidence and practice.
For drafting of the guidelines, Directorate General of Health Services, Ministry of Health and Family Welfare convened a working group comprised of leading experts from cardiology, paediatric cardiology, internal medicine, neurology, nephrology, endocrinology, obstetrics and gynecology, primary care medicine and public health with the technical support of National Heart Foundation of Bangladesh. The working group reviewed recent hypertension and cardiovascular disease treatment and prevention guidelines published by various authoritative scientific and professional bodies and reviewed the recent reports on newer studies related to hypertension treatment. A core writing group compiled the suggestions put forward by the working group and prepared a draft revision of the existing national guidelines. Then consultations among the expert groups were done and a consensus document was finalized by a taskforce committee.