World Hypertension Day is on 17 May, and this year’s theme is Know Your Numbers. Global health physician-photographer Alexander Kumar shares images featuring an innovative social enterprise initiative, which uses a “guerrilla warfare” approach to help fight high blood pressure in Ho Chi Minh City, Vietnam.

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Worldwide, three out of every 10 people have hypertension (high blood pressure); the World Health Organisation has called it the planet’s “number one killer”. Latest figures show 1 billion people have been diagnosed with the condition. But half those people who have high blood pressure are unaware of it and some who are aware do not take any medical action due to access or choice. For World Hypertension Day on 17 May, the theme is Know Your Numbers, with the goal of increasing awareness of high blood pressure.
Photograph: Alex Kumar

Cardiovascular disease prevention and care is challenging for low and middle-income countries. Hypertension causes an estimated 91,000 deaths per year in Vietnam – 21% of all deaths in the country. One in four adults in Vietnam have high blood pressure. Environmental factors such as increasing urbanization, pollution, lack of physical activity, obesity and diets high in salt all contribute to developing hypertension and cardiovascular diseases.
Photograph: Alex Kumar

To overcome a lack of awareness of hypertension and access issues to measurements and treatment, Novartis Foundation and Path, an international nonprofit organisation, set up the Communities for Healthy Hearts initiative in Ho Chi Minh City, in collaboration with the ministry of health, city provincial health department and preventive medicine centre, and Hanoi University of Public Health. Volunteers get support from local health centres. Dr Nam Phuong (right), a cardiologist in Vietnam, is a technical adviser for the project. She was inspired to train in cardiology after her uncle suffered a stroke.
Photograph: Alex Kumar

The initiative is life-saving. It uses a down to earth approach and raises awareness through regular screening, encouraging people to check their blood pressure at least once a year, offering diagnosis, treatment, management and follow-up. Communities for Healthy Hearts brings detection closer to people, using a “guerrilla warfare” approach to make free screening available in non-traditional but convenient locations, including salons, pharmacies, dental offices, neighborhood security posts and in places people congregate, such as coffee shops.
Photograph: Alex Kumar

The Communities for Healthy Hearts programme has established more than 300 free access points to hypertension screening. Screening also takes place in dental surgeries. Here Tuyen, a semi-retired dentist, reassures her neighbour Van, who saw the sign for the free blood pressure checkpoint and decided to see what it was all about. She’s unsure and anxious about the process, but Tuyen puts her at ease by explaining it’s a painless and potentially lifesaving test.
Photograph: Alex Kumar

Ngoc (center, in pink) is working with a local organisation that adapted its expertise as community-based HIV testers to hypertension. They aim to identify new patients by making blood pressure checks available in unconventional yet convenient locations where people gather, such as nail salons.
Photograph: Alex Kumar

Hien (left), proprietor of a local cafe, screens Lang, a customer, who has agreed to have her blood pressure checked before she gets her morning coffee.
Photograph: Alex Kumar

At the back of a busy market is Tran, an underwear vendor. A doctor spotted Tran during outreach activities and offered her a free blood pressure check. Tran, who had undiagnosed hypertension, now has access to follow-up care and support to help manage the condition.
Photograph: Alex Kumar

Digital health tools are a key element of the programme. Patient data is logged and tracked using a searchable database, enabling local health workers to quickly access a patient’s records and to provide follow-up support as needed. The system also features an optional SMS reminder service, allowing patients to receive messages – encouraging them to attend appointments, keep up with treatment and make healthy lifestyle changes – direct to their mobile phones.
Photograph: Alex Kumar