High-income countries such as South Korea, Canada, Germany, the US, and some middle-income countries such as Iceland and Costa Rica have shown remarkable improvements in control and treatment of hypertension.
The number of adults between the ages of 30 and 79 living with hypertension across the globe has doubled over the past 30 years to an estimated 1,278 million (652 million men and 626 million women) in 2019. The figure was an estimated 648 million (317 million men and 331 million women) in 1990. Most of this rise was found to be in low- and middle-income countries. In India, the prevalence has also gone up over 30 years to 38 per cent in men and 32 per cent in women from 29 per cent and 28 per cent respectively.
A World Health Organization-funded international study published in The Lancet analysed the blood pressure measurements of over 100 million people in 184 countries during three decades. Researchers from the Non-Communicable Disease Risk Factor Collaboration conducted the study.
The study defined hypertension as systolic blood pressure of 140 millimetres of mercury (mm Hg) or higher, diastolic blood pressure of 90 mm Hg or higher, or medicating for high blood pressure. Hypertension is straightforward to diagnose and can be treated relatively easily with low-cost drugs. Despite that, nearly half of the people or 51 per cent of the men and 41 per cent of women, with hypertension in 2019 were unaware of the condition. Additionally, over 62 per cent of the men and more than 53 per cent of the women living with hypertension did not get treatment. Medication was used to control blood pressure in fewer than 1 in 5 men and 1 in 4 women with hypertension worldwide.
High blood pressure directly causes over 8.5 million deaths each year worldwide. It is also the leading factor behind ischaemic heart disease, stroke, other vascular and renal diseases. Lowering blood pressure can reduce heart attacks by 20 to 25 per cent, strokes by 35 to 40 per cent, and halve heart failures.
The study also found low hypertension prevalence in high-income countries such as Canada, Spain, Switzerland, and the UK. Central European and low- and middle-income countries such as Paraguay, Poland, Hungary, and Croatia, however, reported high hypertension rates.
High-income countries such as South Korea, Canada, Germany, the US, and some middle-income countries such as Iceland and Costa Rica have shown remarkable improvements in control and treatment of hypertension. Most countries in Oceania and sub-Saharan Africa, however, displayed little change.
The study’s authors called for low- and middle-income countries to follow the best practices in control, detection, and treatment from the likes of Chile, Costa Rica, Kazakhstan, Turkey, and South Africa.
Prof. Majid Ezzati, the senior author and Imperial College London, said the analysis revealed some middle-income countries, alongside high-income countries, showed good diagnosis and treatment practices.
Prof. Avula Laxmaiah, a public health epidemiologist at Hyderabad-based National Institute of Nutrition told The Indian Express that diagnosis of hypertension improved significantly from 1990, rising to 32-42 per cent from 12-19 per cent. Treatment and control levels also improved significantly. However, the levels are still low in comparison with developed countries such as the US, the UK, and Canada.
According to Prof. Avula Laxmaiah, the central government’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented up to the district level since 2010 as part of the National Health Mission. The focus of NPCDCS is on generating awareness for changes in behaviour and lifestyle, screening and early diagnosis of high-risk individuals and referring them to treatment facilities such as CHCs, PHCs, and district hospitals for diagnosis, treatment, and control of non-communicable diseases such as cardiovascular diseases. Prof. Laxmaiah said there the infrastructure and trained manpower, especially at PHCs and sub-centre levels, needed to be improved and to accomplish this.
New WHO guidelines
The WHO’s new guideline for pharmacological treatment of hypertension also provides updated guidelines to help countries improve hypertension management. The WHO has recommended beginning pharmacological antihypertensive treatment in individuals who have confirmed hypertension diagnosis, diastolic blood pressure of ≥90 mmHg, or systolic blood pressure of ≥140 mm Hg.
WHO Department of Noncommunicable Diseases’ Dr. Taskeen Khan, said the new guideline is the first in 20 years and provides current and evidence-based guidance on beginning medicines for hypertension.