• Hypertension affects one in 3 adults worldwide, revealed the World Health Organization’s first-ever report on the devastating global impact of high blood pressure.
• This common, deadly condition leads to stroke, heart attack, heart failure, kidney damage and many other health problems.
• The report shows approximately four out of every 5 people with hypertension are not adequately treated.
• An increase in the number of patients effectively treated for hypertension to levels observed in high-performing countries could prevent 76 million deaths, 120 million strokes, 79 million heart attacks, and 17 million cases of heart failure between now and 2050.
• The report estimates that 31 per cent of India’s population are living with the condition currently. At least 4.6 million deaths in India can be prevented by 2040 if half its hypertensive population controls its blood pressure
• The report was launched during the 78th Session of the United Nations General Assembly which addresses progress for the Sustainable Development Goals (SDGs) including health goals on pandemic preparedness and response, ending tuberculosis and attaining Universal Health Coverage. Better prevention and control of hypertension will be essential to progress in all of these.
What is hypertension?
• High blood pressure is one of the world’s leading risk factors for death and disability.
• Hypertension is a serious, chronic medical condition that increases mortality from cardiovascular and kidney disease. It occurs when the pressure in blood vessels is too high.
• Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart must pump and the more damage this excess pressure causes to many parts of the body, especially the brain, heart and kidneys.
• For the purpose of monitoring population health, hypertension is defined as having systolic blood pressure (SPB) ≥140 mmHg or diastolic blood pressure (DPB) ≥90 mmHg or taking medication for hypertension.
• Hypertension is estimated to affect 33 per cent of adults aged 30-79 worldwide.
• Many factors contribute to the age-related increase in blood pressure that is common in most countries, although the exact causes remain unknown. Genetics undoubtedly play a role, but their specific contribution remains unclear.
• Several general environmental exposures can also contribute to increases in blood pressure, including pollution, very cold temperatures and extreme elevations in altitude. However, the main contributors seem to be personal environmental exposures such as poor-quality diet high in sodium and low in potassium, overweight and obesity, consumption of alcohol, use of tobacco and physical inactivity.
Key points of the report:
• The number of people living with hypertension doubled between 1990 and 2019, from 650 million to 1.3 billion. Nearly half of people with hypertension globally are currently unaware of their condition. More than three-quarters of adults with hypertension live in low and middle-income countries.
• A study of 87 behavioural, environmental, occupational and metabolic risk factors found that high systolic blood pressure (≥110–115 mmHg) was the single most important risk factor for early death worldwide, leading to an estimated 10.8 million avoidable deaths every year, and a burden of 235 million years of life lost or lived with a disability (disability-adjusted life years) annually.
• High blood pressure causes more deaths than other leading risk factors, including tobacco use and high blood sugar.
• Hypertension and its associated complications also have enormous economic costs – for patients and their families, health systems and national economies.
• People living with the condition incur direct medical costs and lose wages, often in their prime working years, which can be impoverishing for entire families. Hospital and outpatient care for heart attacks and strokes caused by uncontrolled hypertension are expensive for health systems.
• Globally, the prevalence of hypertension is slightly higher among males (34 per cent) than females (32 per cent).
Addressing risk factors and managing hypertension
• Hypertension and its associated complications can be addressed. Risk-factor strategies include ensuring that people eat a healthy diet low in sodium, maintain a healthy weight, avoid alcohol and tobacco and take regular physical activity.
• Policies and practices to support these strategies are most effective when implemented across entire populations or within specific settings, such as in schools and at workplaces.
• For people who have hypertension, there are ways to minimise its impact on health and wellbeing. The starting point for living well with hypertension and preventing complications is early diagnosis and early, effective treatment – the longer a person lives with undiagnosed and inadequately treated hypertension, the worse their health outcomes are likely to be.
• Lifestyle changes like eating a healthier diet, quitting tobacco and being more active can help lower blood pressure. Some people may need medicines that can control hypertension effectively and prevent related complications.
• Although hypertension can be prevented and treated, few countries currently do so effectively. Better hypertension management will save lives. Increasing the percentage of people whose hypertension is under control globally to 50 per cent would prevent 76 million deaths between 2023 and 2050. Treating hypertension is one of the most important interventions to meet the Sustainable Development Goal (SDG) target 3.4 of a one third reduction in premature mortality from the leading non-communicable diseases.
• Effective hypertension management will bring health, well-being, and economic benefits. It will reduce burdens on acute-care services, increase integration of health care systems and, most importantly, reduce the deaths, suffering and costs arising from complications such as heart attack, stroke and kidney failure.
Key recommendations of the report:
The report underscores the importance of implementing WHO-recommended effective hypertension care to save lives, which include the following five components:
i) Protocol: Practical dose and drug-specific treatment protocols with specific action steps for managing uncontrolled blood pressure can streamline care and improve adherence.
ii) Medication and equipment supply: Regular, uninterrupted access to affordable medication is necessary for effective hypertension treatment. Currently, prices for essential anti-hypertensive medicines vary by more than ten-fold between countries.
iii) Team-based care: Patient outcomes improve when a team collaborates to adjust and intensify blood pressure medication regimens per doctor orders and protocols.
iv) Patient-centred services: To reduce barriers to care by providing easy-to-take medication regimens, free medications and close-to-home follow-up visits, and making blood pressure monitoring readily available.
v) Information systems: User-centred, simple information systems facilitate rapid recording of essential patient-level data, reduce health care worker data entry burden, and support rapid scale-up while maintaining or improving the quality of care.