For the last few years, 20 to 30 percent of the people brought to the National Institute of Cardiovascular Disease, Karachi, with major heart attacks have been less than 35 years of age. Some of them have been as young as 22 to 25 years of age. This shows the growing incidence of cardiovascular diseases at a younger age in Karachi as compared to other parts of the world.

Cardiologists at the NICVD found that many of the young patients lack traditional risk factors for cardiovascular diseases, including diabetes, hypertension and smoking. This indicated that something else was causing heart attacks, resulting in deaths at a young age.

“During my investigation, it emerged that unhealthy diet was the major culprit behind growing cardiovascular disease in addition to physical inactivity and air pollution in Karachi. People in Karachi, especially youngsters, eat unhealthy diets, mostly rich in carbohydrates and fats. They don’t exercise or play games. Air quality in Karachi too is worse than most other parts of the world,” says Dr Sohail Khan, a former NICVD CEO.

Similar trends have been observed in other major cities of Pakistan, including Lahore, where people in early 20s and 30s are being brought to health facilities with major heart attacks, cardiologists say. They blame the early onset of diabetes and hypertension due to sedentary lifestyle, carbohydrate-rich diets and physical inactivity for a surge in cardiovascular diseases in the country.

Prof Dr Tahir Saghir, executive director of the NICVD, Karachi, confirms that the number of young people having heart attacks is on the rise in Pakistan. He says people are becoming diabetic at an early age. This increases risk for cardiovascular disease.

“Of the 1,000 people brought to us for heart attacks, 50 to 100 are very young, between 20 and 30 years of age,” says Prof Saghir.

The NICVD executive director says that consumption of high-calorie diet is fattening people as they are not in the habit of playing games and doing exercise. He advises people to control their weight, eat a healthy diet and ensure proper sleep at night to remain healthy and avoid contracting diabetes and hypertension.

Dr Somia Iqtidar, physician and professor of medicine in Lahore, says that people as young as 25 to 29 years of age are having heart attacks in Lahore.

“We are seeing an early onset of diabetes and other metabolic problems, including hypertension, which is leading to cardiovascular diseases in Lahore and other parts of the country. Obesity and smoking are other risk factors causing heart problems in young people,” she says.

“These days, we are witnessing a significant increase in hypertension cases among young adults in Pakistan, largely stemming from sedentary lifestyles characterised by physical inactivity, poor dietary habits, excessive salt and sugar intake and smoking,” says Dr Junaid Patel, a professor of medicine at the Indus Hospital, Karachi.

“It is alarming to see individuals as young as 16-18 years old experience dangerously high blood pressure levels, leading to strokes and heart attacks,” he adds.

According to a recent report by the World Health Organisation, the number of people living with hypertension (blood pressure of 140/ 90 mmHg or higher, or taking medication for hypertension) doubled between 1990 and 2019, from 650 million to 1.3 billion. Nearly half of the people with hypertension globally are currently unaware of their condition.

“Of the 1,000 people brought to us for heart attacks, 50 to 100 are very young, between 20 and 30 years of age,” says Prof Saghir.

In Pakistan, hypertension prevalence is 44 percent, compared to 33 percent globally, states the WHO, adding that around 56 percent of hypertensive patients in Pakistan remain undiagnosed. Among the diagnosed patients, 65 percent are not receiving any treatment at all.

Dr Patel calls for a massive awareness drive in the country – discovering hypertension, urging the public and private sectors to join hands in identifying and effectively treating people afflicted with hypertension.

“We need to place digital blood pressure monitors at mosques, medical stores, shopping centres, hair salons and restaurants to check people for hypertension,” he says.

“A reading ranging from 120 to 129 (systolic) and below 80 (diastolic) shows elevated/ low blood pressure. A reading ranging from 130 to 139 (systolic) or 80 to 89 (diastolic) indicates Stage 1 hypertension. Stage 2 hypertension registers a reading of 140 or higher (systolic) or 90 (diastolic).”

Health experts say that extremely elevated blood pressures are observed among some hypertensive individuals, especially during Ramazan due to poor eating habits, lack of exercise and avoidance of medication. They urge people to improve their lifestyles to avoid strokes, heart attacks and other serious health issues.

“Salt and oil intake increases during Ramazan as we regularly consume fried, salty items during iftar,” says Dr Patel. “We regularly dine out, eat unhealthy food and while most people don’t exercise during the holy month. Many hypertensive people don’t even take their medicines regularly.”

He says that uncontrolled hypertension is symptomless. It is a silent killer, often resulting in hypertensive heart failure, strokes or heart attacks due to high blood pressure. Hypertension can often lead to kidney failure, blindness and amputation of the lower limbs.

Pakistan Hypertension League patron Prof Muhammad Ishaq says that there are around 33.2 million people with hypertension in Pakistan, of which around 18.59 million are undiagnosed. “Only 5.11 million are currently receiving treatment for hypertension. Of those, just 1.61 million have their hypertension under control.”

Prof Ishaq blames lack of awareness among the masses as the major cause of high prevalence of hypertension in Pakistan. He is planning to launch a massive drive in May to screen people for hypertension.

“We are going to involve nurses, healthcare workers and common people in our Discovering Hypertension drive,” he says. He urges people to adopt a healthy lifestyle, reduce salt intake, exercise daily and avoid smoking.

Cardiologist Dr Akram Sultan says salt intakes are very high in Pakistan, particularly among Pakhtun populations. This, he says, is a major contributor to arterial hypertension. He says obesity is prevalent due to a lack of exercise and consumption of junk food.

Agreeing that the younger population is becoming hypertensive, Dr Sultan calls for awareness at school level as well as mass awareness and screening campaigns in the country to diagnose people with hypertension.

“We need mass awareness and frequent screening campaigns in Pakistan to diagnose people with hypertension. Every person going to a doctor, even for diarrhoea or a mental health issue, should be screened for hypertension. Nowadays, we should screen even youngsters for hypertension due to our poor lifestyles.”