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“Elevated blood pressure presents a significant global health challenge, ranking as one of the leading risk factors for mortality and disability on a worldwide scale. The period spanning from 1990 to 2019 witnessed a doubling in the prevalence of hypertension, characterized by blood pressure levels equal to or exceeding 140 mmHg systolic or 90 mmHg diastolic, or under medical treatment, surging from 650 million individuals to a staggering 1.3 billion (1).
This widespread yet insidious health issue poses a substantial public health conundrum, precipitating a range of severe health consequences, including strokes, heart attacks, heart failure, kidney impairments, and a host of other maladies (2, 3). A comprehensive analysis of 87 behavioral, environmental, occupational, and metabolic risk factors pinpointed elevated systolic blood pressure (≥110–115 mmHg) as the most significant contributor to premature mortality on a global scale. Alarmingly, it is linked to an estimated 10.8 million preventable deaths annually and an overwhelming burden of 235 million years of life marked by disability, as measured by disability-adjusted life years (DALYs) (3). High blood pressure claims more lives than other prominent risk factors, surpassing both tobacco use and elevated blood sugar levels.
The repercussions of hypertension extend well beyond health implications and encompass considerable economic consequences. Individuals grappling with this condition face direct medical expenses and frequently endure wage losses, often during their peak earning years, imposing financial strain on entire families. Health systems grapple with substantial financial burdens due to the costly hospitalization and outpatient care required for heart attacks and strokes stemming from uncontrolled hypertension. National economies suffer from reduced tax revenue, diminished productivity, increased healthcare expenditures, and heightened societal responsibilities to support adults recovering from heart attacks and strokes, as well as children left without parents or burdened with caregiving responsibilities. According to one estimate, the economic benefits derived from enhanced hypertension treatment programs far outweigh their associated costs by an impressive ratio of approximately 18 to one.”
Confronting Hypertension: Risk Factors Assessment and Effective Management
The positive news is that hypertension, along with its associated complications, can be effectively managed. Strategies aimed at mitigating risk factors include promoting a balanced diet with reduced sodium intake, maintaining a healthy weight, refraining from alcohol and tobacco use, and engaging in regular physical activity – all of which contribute to overall well-being. The most impactful approaches for supporting these strategies are those implemented across entire populations or within specific settings, such as schools and workplaces.
For individuals grappling with hypertension, there exist avenues to mitigate its impact on health and overall well-being. The crucial starting point for leading a healthy life with hypertension and averting potential complications is early diagnosis and effective treatment. The longer an individual lives with undiagnosed or inadequately treated hypertension, the more severe their health outcomes are likely to be. Presently, among adults aged 30–79 years with hypertension, only 54% have received an official diagnosis, 42% are actively undergoing treatment, and 21% have their hypertension effectively controlled (4).
In some countries and healthcare systems, large-scale hypertension control programs have successfully achieved blood pressure regulation for many patients, contributing to their prolonged, healthier lives. The World Health Organization (WHO) HEARTS technical package offers cost-effective strategies that can be implemented at the primary healthcare level to control blood pressure and prevent heart attacks, strokes, and other complications. Key components of this package include standardized drug- and dose-specific treatment protocols, consistent access to quality-assured medications, team-based care, patient-centered services, and a robust monitoring system to track patient progress and healthcare system performance. Establishing follow-up and referral systems is also crucial to improving treatment outcomes. The implementation of the HEARTS package, alongside the necessary enhancements to the healthcare system for integrated services, demonstrates that many of its components also support and can be applied to other health issues requiring sustained, long-term care, such as diabetes, chronic kidney disease, and HIV/AIDS.
Despite the preventable and treatable nature of hypertension, few countries are currently addressing it effectively. Enhanced hypertension management has the potential to save lives. Raising the global percentage of individuals with controlled hypertension to 50% would prevent an estimated 76 million deaths between 2023 and 2050. Treating hypertension is a critical intervention to achieve Sustainable Development Goal (SDG) target 3.4, which aims for a one-third reduction in premature mortality from the leading non-communicable diseases.
Key Takeaways and Final Remarks
“Improving the prevention and treatment of hypertension is not only possible but also cost-effective, safe, and imperative for achieving global and national targets, including those outlined in the Sustainable Development Goals (SDGs). Effective management of hypertension holds the promise of delivering health, well-being, and economic benefits. It alleviates the strain on acute-care services, promotes the integration of healthcare systems, and, most critically, reduces the loss of lives, human suffering, and financial burdens associated with complications such as heart attacks, strokes, and kidney failure.
Join us in the global effort to combat this silent killer: The Hypertension Challenge.”