Tuesday, December 5, 2023
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A new global political and public commitment to high blood pressure control is called for in a new report endorsed or supported by a number of national and international medical associations, including the American Society of Hypertension, the European Society of Hypertension, and the International Society of Hypertension. The report reviews the evidence that a "serious epidemic" will develop by 2025 unless more action is taken, and calls for government and healthcare policy-makers to address the "rapidly accumulating burden of high blood pressure" through targeted education, better management strategies, enhanced medical collaboration, and improved medications.
Entitled "High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next," the report was funded by an unrestricted educational grant from Novartis Pharma AG. It is published by Rudder Finn (New York, NY) and it is posted on the Nephrology Gateway Web site of the International Society of Nephrology (http://www.nature.com/isn/index.html).[2]
The authors of the report -- Panos Kanavos, PhD (The London School of Economics, London, United Kingdom), Jan Östergren, MD, PhD (Karolinska University Hospital, Stockholm, Sweden), and Michael A. Weber, MD (State University New York Downstate Medical College, New York, NY) -- assert that high blood pressure "continues to be grossly underestimated by patients and their families, healthcare decision makers, politicians, the media, and the public, despite its dangerous and far-reaching consequences." They contend that if high blood pressure were an infectious disease, "we would mobilize against it as if it were avian influenza or AIDS." They warn that without more emphasis on modifying lifestyles and diagnosis and treatment of high blood pressure, "late 20th century societal gains in treating cardiovascular disease can and will stagnate or diminish, putting both individuals and healthcare systems at unnecessarily [their emphasis] greater risk."
The report cites recent studies that about 1 billion people -- approximately 25% of the world's adult population -- currently have hypertension, causing 7.1 million deaths annually and an even greater number of debilitating cardiovascular disease events.[3-5] People in nations with rapidly Westernizing economies, such as Brazil, China, India, and Russia, are likely to see an 80% increase in the incidence of hypertension by 2025, the authors note. Taking action now could result in savings of billions of dollars in worldwide direct and indirect healthcare, they say. "Even more important, though, are the savings in terms of human cost -- the millions of otherwise unnecessary victims of heart attacks, strokes, and heart and kidney failure due to uncontrolled or inadequately controlled high blood pressure."
The Call to Action outlined in the report involves:
Public policy must advocate and encourage healthy nutrition, reduced salt intake, smoking cessation, physical activity, and weight loss. When lifestyle modification is insufficient to control blood pressure, patients must be given access to appropriate medicines and the information and motivation to use them effectively.
If this is not done, hypertension prevalence will increase by more than 60% over the next 20 years and trigger a global epidemic of hypertension-driven cardiovascular disease.
In developing countries this action should involve the donor community, intergovernmental organizations, nongovernmental organizations, civil society groups, philanthropic foundations, the private-for-profit sector, health professionals, and the research community, united as they are against infectious diseases.
"It is a sad irony that we know so much about the costs of the diseases that high blood pressure helps cause, and so little about the value of preventing them through effective high blood pressure control," the authors say. Among their policy recommendations, they advocate setting global standards for blood pressure goals and conducting new long-term clinical outcome and epidemiologic studies to measure the costs and benefits of reducing high blood pressure targets from < 140/90 mm Hg to more ambitious goals. They also suggest that pharmacogenomic research tools could be useful in identifying patients at highest risk and for determining appropriate treatments and interventions. "It is our challenge now to move the project from talk to action," they say.
At the launch of the report, Dr. Kanavos said:
High blood pressure is a condition whereby incidence increases with age, but this does not mean that it is a problem that only affects old people. Uncontrolled high blood pressure among people in their 30s, 40s, and 50s will inevitably lead to an increase in cardiovascular disease and stroke that will strike down men and women at the height of their earning power, potentially turning them from drivers of economic growth and sources of public revenues to long-term recipients of extensive social benefits with increased healthcare needs. A concerted public policy effort to prevent cardiovascular disease through more aggressive high blood pressure diagnosis, treatment of high blood pressure and its underlying causes, and monitoring will save productive lives and cut healthcare costs among adults in the prime of their lives.
Dr. Weber stated:
Over the past 40 years, focused efforts to diagnose and control high blood pressure have helped to achieve significant reductions in cardiovascular disease, stroke incidence, and death. However, we have become complacent about these achievements. The rate of cardiovascular disease reduction has leveled off and the number of people with uncontrolled high blood pressure is once again on the rise. We cannot afford to ignore high blood pressure control at this critical point.
Dr. Östergren said:
European public health officials are only now beginning to realize that we need to do a better job at reducing cardiovascular health risks and that controlling high blood pressure is a key means for doing this. The problem is also especially worrying in Eastern Europe and the rapidly westernizing nations of the Middle East, Asia, Latin America, and Africa. Uncontrolled high blood pressure is a public health dilemma that requires an urgent global and national response.
