Abdullah Al Shafi Majumder

Hypertension in Bangladesh: a review.

Hypertension (HTN) is an increasingly important medical and public health problem. In Bangladesh, approximately 20% of adult and 40-65% of elderly people suffer from HTN. High incidence of metabolic syndrome, and lifestyle-related factors like obesity, high salt intake, and less physical activity may play important role in the pathophysiology of HTN. The association of angiotensin-converting enzyme (ACE) gene polymorphism and low birth weight with blood pressure has been studied inadequately. Studies have found relationship between mass arsenic poisoning and HTN. Hypovitaminosis D presumably plays role in the aetiopathogenesis of HTN in Bangladeshi population. South Asians appear to respond to antihypertensive therapy in a similar manner to the Whites. The latest National Institute for Health and Clinical Excellence guideline advocates a calcium-channel blocker as step 1 antihypertensive treatment to people aged > 55 years and an ACE inhibitor or a low-cost angiotensin-II receptor blocker for the younger people. Calcium-channel blockers and beta-blockers have been found to be the most commonly prescribed antihypertensive drugs in Bangladesh. Non-adherence to the standard guidelines and irrational drug prescribing are likely to be important. On the other hand, non-adherence to antihypertensive treatment is quite high. At the advent of the new millennium, we are really unaware of our real situation. Large-scale, preferably, nation-wide survey and clinical research are needed to explore the different aspects of HTN in Bangladesh.

Coronary artery disease in Bangladesh: A review

Coronary artery disease (CAD) is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Large scale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh.

Rheumatic fever and rheumatic heart disease in Bangladesh: A review

Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common cardiovascular disease in young people aged <25 years, globally. They are important contributors to cardiovascular morbidity and mortality in Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance, and insufficient health care services were responsible for the high incidence and prevalence of these diseases over the last century. In concert with the progresses in socioeconomic indicators, advances in health sectors, improved public awareness, and antibiotic prophylaxis, acute RF came into control. However, chronic RHD continues to be prevalent, and the actual disease burden may be much higher. RHD predominantly affects the young adults, seriously incapacitates them, follows a protracted course, gets complicated because of delayed diagnosis and is sometimes maltreated. The treatment is often palliative and expensive. Large-scale epidemiological and clinical researches are needed to formulate evidence-based national policy to tackle this important public health issue in future.