“How we diagnose hypertension is very important”

Dr Narsingh Verma, Secretary General, Indian Society of Hypertension believes that the lack of awareness among both doctors and patients is complicating the hypertension burden in India. 

In an exclusive face to face interaction with the BioVoice, Dr Verma who wears many hats such as Fellow of Diabetes India, Professor of Department of Physiology and Vice Dean, Faculty of medicine, shared detailed insights about the hypertension situation in India, improper diagnosis, awareness and much more. Read on:

What is the current status of hypertension burden in India? 

I would say that hypertension is a major disease burden that India is facing among chronic disease segments. We estimate that more than 38 percent of Indians are suffering from it. We don’t have the exact data but this is the approximate yet closer figure. The bigger issue is that in India we don’t have much healthcare facilities for the patients. While physicians are aware of drugs, they are not very good in diagnosing the various kinds of hypertension related problems. And that is where the difference lies as how and when we diagnose hypertension correctly is very important.

What are the current issues with the blood pressure measurement and management? 

To diagnose the hypertension is not easy for them as the office measurement is not mostly inaccurate due to white coat (doctors) fear. Then there is masked hypertension as during clinical measurement the BP is normal but at home it is normal. We are lacking the good initiatives in diagnosing the disease correctly. So, the aim should be to focus on the correct diagnosis. For that, it is necessary to see how we measure the BP. There are many ways: one is office, second is home, third is ambulatory where we put a machine so that we are able to record for a week. It is cumbersome due to magnanimity and cost. 

Why are home based BP Monitors an option? Is there enough awareness about it among the common masses in India? 

In our country, only 30 percent of those who are actually hypertensive are diagnosed and out of those only 30 percent are being treated out of that only 34 percent are actually complying to treatment. There are 40 percent false positive and 40 percent false negative cases that are pending. The false positive ones are those who don’t have hypertension but are still labelled as hypertensive as against the false negatives who are called non hypertensive when they are actually hypertensive.

Hence, the home measurement is considered the best one as the patient gets to check the BP regularly and record the data too. The data could be collected weekly by the patients and later shown to doctor to check if the person is really hypertensive. 

How do you react to the criticism around the accuracy of the digital monitors? Do we have the quality issues in India?

The home monitoring also ensures compliance and good control. It has been proved beyond doubt. However, in India, the home monitoring is not upto the mark. In Indian scenario, the new things take time to get adjusted. Similarly, the BP monitors necessitated by the changing lifestyle and its diseases are still not understood well.

The doctors don’t know much because the BP training is only provided in the first year of their course. So are not aware about the latest trends while thinking that mercury monitor is the best not knowing mercury has been banned all over the country. The ban is on paper as it is not effective. Mercury nanometers should be phase out.

Another issue is that we don’t have quality monitors. The online seller platforms like Amazon sell all sorts of monitors which aren’t even certified. We don’t have the accredited monitors.

What is the problem with Indian BP monitors?

Only problem with Indian BP monitor devices is that they are not accredited and do not have the quality. The description doesn’t specify how many times it will work and what is the life span. It needs more research and calibrations that can be done by actual manufacturers and not all. The real manufacturers are those who have been in the business for longer time and earned a reputation. 

Another problem is that patients and doctors are not forthcoming about the latest technology. We are trying to build awareness on that front.

What is the problem with regulations?

Because of the pressure from industry, awareness, advertisements, people do buy monitors but there are no advisors to educate them which are good or bad monitors. Internationally, there are many bodies to do accreditations but in India, there is no standard as anybody can manufacture the monitors. There are no set guidelines or qualifications for the manufacturer.

In other countries it is not possible. The license is given to specifically those who manufacture devices. Here anybody can do it, from the manufacturers of thermometers to glucometers, tooth brushes to soaps. This is not right. It should not be allowed at all.

Do people buy the cheap ones due to the cost?

This is important one. Cost is a factor but we have to understand that it is also a marker for quality. It can’t be compromised.