Thank goodness, sutukil doesn't kill or why overhaul the ambrosial tang of freshly caught seafood with a shower of salt and flavor enhancers that are largely salt-based? But to picky eaters given to the tease and temptations of rich flavors or the assault of lush brine, sutukil comes out bland, too tame and subdued, or maybe too subtle for their taste buds. Excepting Iloilo's fat-and-brine wallow in a bowl called La Paz batchoy, sutukil seems to be lacking in salt. Even its dipping sauce of sinamak (palm vinegar, ginger slices, chili peppers, whole peppercorns, shallots, and garlic cloves) hardly adds any tongue-pleasing saltiness. As any physician worth his salt would counsel, a fairly high intake of salt-in all its guise and disguise on the dinner table as patis, bagoong, nuoc mam, toyo, halobaybay, et al.- exceeding 5.8 grams a day is body- English invitation to essential hypertension or simply, high blood pressure.

    While the region is packed with 17 cities-the most number in all the country's 17 regions-living is likely laid back and busy yet easy in any of the seven provinces (Aklan, Antique, Negros Occidental, Capiz, Guimaras, Iloilo, and Palawan) that make up Western Visayas.

    Being busy yet easy is essential to being content and a lifestyle like that doesn't induce hassles like hypertension.

    Or long-time dwellers in the region could have been blessed with good genes, thanks to their forebears and ancestors of yore since 30 percent of cases of essential hypertension can be traced to genetic factors.

    The region registered the lowest prevalence of hypertension among adults (18 years and above) in the country in the latest survey dubbed Presyon 2: Target Organ Damage conducted by the Philippine Heart Association (PHA) last year.

    While the data showed that on the national level, one of every five adult Filipinos (21 percent) is hypertensive, only nine in every 100 in Western Visayas are saddled with the affliction that rakes in some $60 billion a year for the world's pharmaceutical companies churning out medications to rein in rising blood pressure.

    The PHA shared initial findings of the survey with MEDICAL OBSERVER in time for the annual PHA convention where the complete results were to be presented in a symposium on May 17.

Highest in Metro Manila

    Metro Manila registered the highest rate-an epidemic level of one per three residents, outclassing the one in every four in the entire United States. Southern Tagalog ranked second (26 percent), followed by the Bicol Region (23 percent). Equaling the national prevalence level-one of every five-are Cagayan Valley, Central Luzon, Central Visayas, Eastern Visayas, and Northern Mindanao. Both Southern and Central Mindanao has 16-percent prevalence; Ilocos region is at 17 percent.

    The less risk-prone areas turned out to be Western Mindanao with about a dozen hypertensives for each 100 screened and Western Visayas with nearly one hypertensive for every 10.

    As expected, hypertension prevalence is higher among urban dwellers-one in every four or 24 percent. Rural residents are less prone with about less than one hypertensive for every five individuals screened (18 percent).

    The survey, carried out in association with Applied Marketing Research Inc. and a grant from Sanofi-Aventis Philippines, had a sample base of 3,415 with 51 percent females and 49 percent males.

    Overall, the prevalence of hypertension was found to be equal among men and women. Differences, however, were noted between genders by age groups. There were more male hypertensives (74 percent) than female hypertensives (26 percent) among those 18 to 29 years old. But the gender distribution reversed as the age group rose-55 percent males against 45 percent females in the 30 to 39 age group, 52 versus 48 in the 40 to 49 age group, 47 versus 53 in the 50 to 59 bracket, 45 versus 55 in those 60 to 69 years old, and 44 versus 56 among those 70 and above.

    Dr. Emma Trinidad, chair of the PHA council on hypertension, which led the survey, said that the gender tilt by age groups may partly be explained by the "hormonal protection" that younger women enjoy, which diminishes as they reach menopause.

    Presyon 2 also included individuals below 18 years old, and found that one percent of them are hypertensives.

    Another interesting finding was the level of awareness among those found to be hypertensive-an overwhelming 80 percent were aware of their condition while only 20 percent were not, indicating perhaps that the information campaigns being conducted by the PHA, other medical societies, and the Department of Health are slowly paying off.

    Presyon 2, a follow-up to Presyon 1 conducted in 1997, also gathered data on the physical attributes (height, weight, waist and hip circumference), eating habits, and physical activities among Filipinos, as well as the nature of organ damage among those suffering from hypertension.

BP Awareness Campaign 2007

    In a bid to rev up people's awareness on the risks of hypertension, PHA also carried out the largest blood-pressure screening so far done in the Philippines. Conducted on February 1 with the help of the Vice Mayors League of the Philippines and Unilab-Therapharma, the PHA's BP Awareness Campaign 2007 aimed for the record books and screened 99,874 persons for hypertension nationwide in identified parks, plazas, malls, and churches. Trained BP takers, volunteer doctors, midwives, nurses, and nursing students took the BP readings using standard BP cuff size. Those who had high BP readings were referred to volunteer doctors at the sites for reevaluation, counseling, and possible referrals to clinics or hospitals if immediate treatment was necessary.

    While the number was shy of the record books, the size of the sample population makes it difficult to just disregard the results, which were more than an eye-opener for local health professionals to see the inroads of the so-called "silent killer" on the populace.

    The results showed that 36.7 percent had hypertension-24.6 percent stage I and 12.1 percent stage II. Four in ten were in the prehyhpertensive stage while only 22.5 percent had normal BP.

    An interesting finding in the PHA campaign involved those with blood-pressure levels below normal (below 90 systolic) but without symptoms. There were 668 of them or less than one percent of the total sample population. Of these, 89 percent had systolic blood pressure between 80 and 89 mm Hg, five percent between 70 and 79, and 11 percent less than 70.

    Noted the PHA: "On the other end of the spectrum are those with low blood pressure or a systolic BP of less than 90 mm Hg. PHA contends that assigning a value as to what is considered hypotension is quite arbitrary. The lower limits of what is normal have never really been defined. Blood pressure is expected to be lower in children compared to adults. In this study, it was more common in females, age 18 to 30, and with normal weight. This is quite interesting. It is probably telling us to look further into what should be considered as normal blood pressure for Filipinos."

    The nationwide study has also given further credence to the association between being overweight or obese and the occurrence of hypertension, which was noted in all age groups.

    The PHA was able to obtain data on height and weight from 52,593 (53 percent) of those screened, allowing for computation of their body-mass index (BMI). The PHA found that 3,385 (6.4 percent) were underweight (BMI <18.5), 18,723 (36 percent, were normal (BMI 18.5 to 22.9), while 30,480 (57.46 percent) exceeded the normal weight with 8,147 (15.5 percent) overweight (BMI 23 to 24.9), and 22,333 (42.46 percent) obese (BMI =25).

    The prevalence of low blood pressure was significantly higher among underweight and normal-weight individuals than the overweight and obese. The prevalence of normal BP was highest in the underweight followed by the normal weight, overweight, and obese, with all differences being statistically significant. Prehypertension was significantly higher in the overweight group than in the underweight, normal, and obese. And finally, hypertension was significantly higher in the obese group compared with the underweight, normal, and overweight, while the overweight had significantly higher prevalence of hypertension compared with the underweight and normal.

    "These findings support the view that overweight and obesity increase the risk for hypertension. The same pattern was found in all age groups 12 to 17, 18 to 30,31 to 40, 41 to 60 and over 60, although statistically significant only in those 18 years old and above," the PHA noted.

    Meanwhile, only 137 of the subjects were less than 12 years of age. Those over 12 years of age numbered 99,737, with 22,346 from Metro Manila, 52,903 from Luzon, 11,180 from Visayas, and 13,308 from Mindanao.

    Of those screened 2,529-one in four-were in the 12 to 17 age bracket; 21,980 (22 percent) in the age group 18 to 30; 19,966 (20 percent) in the 31 to 40 age range; 37,838 (37.8 percent) were aged 41 to 60; and 14,635 (14.6 percent) were 61 years old and above. More females participated in the screening-55,671 (55.7 percent) while 43,170 (43.2 percent) were males.

    The prevalence of hypertension seen in this screening program is higher than that reported in Presyon I (22 percent), Presyon 2 (21 percent), and the 2003 National Nutrition and Health Survey (17.7 percent). The PHA pointed out that these three studies were all nationwide surveys with multilevels of randomized sampling and are, therefore, more reflective of the true prevalence of hypertension in the Philippines.

    On the other hand, the data obtained from the BP Awareness Campaign were taken from previously identified BP screening sites nationwide that were located in urban areas and, therefore, probably reflect the prevalence of hypertension in the urban population of the Philippines, the PHA explained. Subjects for the BP Awareness Campaign voluntarily came to have their BP checked. "It is likely that many of those who came felt that their BP was abnormal and, therefore, wanted it checked. Also, the reported blood pressures were taken only once. All of these explain the higher prevalence of hypertension noted in the BP Awareness Campaign data," the PHA added.

    Still, the PHA noted that the data from the BP Awareness Campaign showed very consistent prevalence rates of low BP, normal BP, prehypertension, hypertension stage I and II when taken as a whole and when divided into such areas as Metro Manila, Luzon, Visayas, and Mindanao.

Silent killer

    High blood pressure is tabbed as "silent killer" as it usually causes no symptoms for many years, even decades, and the disease can progress silently until it finally damages certain critical organs.

    High blood pressure won't kill the hypertensive, assures Trinidad, a cardiologist at the Cardinal Santos Memorial Medical Center, saying the affliction is a precursor to the more notorious top killers-stroke, heart attack, and kidney failure.

    Chances are, a patient's first contact with a physician takes place after significant damage to the end organs has occurred, and not infrequently, the patient is brought to the doctor or wheeled into the emergency room struck down with a heart attack, stroke, kidney failure, or impaired vision leading to blindness, she cites.

    In deference to Sun Tzu's nugget on winning strategy-"Know yourself; know the enemy; in a hundred battles gain a hundred victories"-heart specialists have backstopped awareness campaigns with a view to keeping the public informed how to engage a silent killer and come out with greater chances of winning.

    Hypertension means high tension in the arteries, the network of vessels that carry blood from the heart to all tissues and organs of the body. "High blood" as plied in the current Filipino idiom means excessive emotional tension, usually in a fit of pique or choke of rage-but that's not what it is, and is even reflected in a 16-percent national level of awareness on hypertension", explains Trinidad.

    "Even a single stick of cigarette can raise blood-pressure level through vasoconstriction," she added.

    As experts point out, normal blood pressure is below 120/80 mm Hg; blood pressure between 120/80 mm Hg, and 139/89 is called "prehypertension." High blood pressure is 140/90 mm Hg or above. A raise in the systolic and/or diastolic blood pressure increases the risk of developing heart disease, kidney disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and brain damage. These complications of hypertension and mayhem upon vital body organs-the so-called end-organ damage-stem from chronic high blood pressure.

    Individuals at prehypertension stage may benefit from lowering blood pressure by lifestyle modification, which isn't exactly easy to do. "The individual's will is the telling factor to modify one's lifestyle and discard habits-smoking, too much caffeine intake, for example-that abet hypertension", said Trinidad.

    Urban living is a humdrum carried out at a punishing pace to keep body and soul together-with missed meals, skipped meals, and fast-food meals fast becoming a normal way of life for breadwinners. No wonder then that those in the middle-income groups, the so-called broad C, are most prone to hypertension at 29 percent while those in E or the have-nots, notch a low 16-percent level of prevalence. The haves (A, B, and C+ income brackets) and the not-so-poor D group are respectively at 22-percent and 21-percent level.

    There may be missed meals and skipped meals for urbanites but the copious intake of empty calories slathered with tons of salt in in-between meals could be the culprit in the high prevalence of hypertension in cities. There's too much salt in junk food, even in instant noodles, which are now becoming a national food of sorts.

    "Maybe, junk food packets should be labeled with a similar warning in cigarette packs, 'Government Warning: Cigarette Smoking is Dangerous to Your Health.' High salt intake is also dangerous to the individual's health," said Trinidad. M

 

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