Hypertension, or high blood pressure, is growing at an alarming rate worldwide according to recent data published in The Lancet.
The research – accessible here – found that the number of individuals living with hypertension doubled in the last three decades. The world’s hypertensive population now exceeds 1.2 billion, with researchers sounding the alarm on a lack of hypertension management practices in spite of medical advances. Low- and middle-income countries account for over one billion, or 82 percent, of the world’s peoples living with hypertension.
“Despite medical and pharmacological advances over decades, global progress in hypertension management has been slow, and the vast majority of people with hypertension remain untreated, with large disadvantages in low- and middle-income countries,” said Professor Majid Ezzati, Imperial College London, UK, the senior author of the study. “Our analysis has revealed good practice in diagnosing and treating hypertension not just in high-income countries but also in middle-income countries.
“These successes show that preventing high blood pressure and improving its detection, treatment, and control are feasible across low- and middle-income settings if international donors and national governments commit to addressing this major cause of disease and death.”
In India, the report found the prevalence of hypertension to be 32 percent among males and thirty percent among females. The country accordingly took 37th place in global rankings (low to high) and placed 143rd in global rankings when ranked vice versa.
“The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings,” the study said. However, it noted that “Improvements in the detection, treatment, and control of hypertension have varied substantially across countries.”As Health Issues India reported on the occasion of World Hypertension Day earlier this year, hypertension is a major risk factor for the development of cardiovascular disease (CVD). Heart disease is India’s leading cause of death and addressing it must involve addressing root causes. According to the World Health Organization (WHO), “nearly 63 percent of total deaths in India are due to noncommunicable diseases, of which 27 percent are attributed to cardiovascular disease which affects 45 percent[of] people in the 40-69 age group. Raised blood pressure is among the most important risk factors for CVDs.
“Moreover, it remains poorly controlled due to low awareness about hypertension, lack of appropriate care through primary care and poor follow up.” As we previously noted, the Indian Council of Medical Research (ICMR) has estimated that 10.8 percent of deaths in India are attributable to hypertension. Meanwhile, the burden is growing as the latest research shows in alignment with trends discerned by previous studies. In 2019, we reported
“One study which compared cross-sectional surveys in urban and rural areas from 1991 to 1994 and 2010 to 2012 found a rise of 23.0 percent to 42.2 percent and 11.2 percent to 28.9 percent in urban and rural areas, respectively. This reflects that hypertension is showing a significant increase over time.”
For treatment and prevention, as we noted in a disease profile, “prevention is the best method for combating hypertension. This can be done through avoiding risk factors and following healthy habits such as eating a healthy diet and regular exercise. Medications are available that can reduce blood pressure and treat hypertension. Some of the more commonly used medications are beta blockers, thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors. These all fulfil a similar role in reducing overall blood pressure, though do so via differing chemical mechanisms.” Checking one’s numbers is key, as the WHO makes clear
“Measurement of blood pressure is quick and painless. Written as two numbers, the first (systolic) number represents pressure in blood vessels when the heart contracts or beats and [the] second (diastolic) number represents pressure in the vessels when the heart rests between beats. Hypertension is diagnosed if, when measured twice on different days, systolic blood pressure on both readings is ≥140 mmHg and/or diastolic blood pressure on both readings is ≥90 mmHg. It is important to know one’s blood pressure reading by checking it regularly, adopting a healthy lifestyle and staying on prescribed treatment to reduce hypertension and its complications.”
Indeed, improving lifestyles is key. As Ezzati states, “policies that enable people in the poorest countries to access healthier foods—particularly reducing salt intake and making fruit and vegetables more affordable and accessible—alongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries.”
Despite the severity of the crisis, there is an ostensible “standstill” even as we weather a low control rate. According to Dr Clara Chow from the University of Sydney in Australia (uninvolved with the recent research but who contributed a linked comment), “the standstill in global prevalence and the global control rates of approximately twenty percent should serve as an important global wakeup call that cardiovascular disease is going to be a main burden of disease for many years to come, especially if we carry on like this.”
The question then becomes: do we want to carry on like this? In a time when we are seeing the crippling effects of overburdened health systems, battling crisis after crisis in tandem with sometimes no end obviously in sight, the answer surely should be no. Raising awareness, providing treatment and diagnostics, and other best practices are effective, efficient, and potentially life-saving.
“Low detection and treatment rates that persist in the world’s poorest nations, coupled with the rising number of people who have hypertension, will shift an increasing share of the burden of vascular and kidney diseases to sub-Saharan Africa, Oceania and south Asia”, said study co-author Leanne Riley from the WHO in Switzerland. “Improving the capacity of these countries to detect and treat hypertension as part of primary health care and universal health coverage must be accelerated.”
“Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants” can be accessed here.