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Low and middle-income countries now carrying the burden of hypertension, new report finds

Over the last 30 years, the burden of hypertension has shifted from wealthy nations to low and middle-income countries, according to a report led by Imperial College London and the World Health Organization (WHO). The first comprehensive analysis of trends in hypertension prevalence, detection, treatment and control, published on Wednesday in The Lancet, also found that the number of adults aged 30-79 years with hypertension has doubled from 650 million to 1.28 billion and nearly half these people did not know they had hypertension. “It's far from being a condition of affluence. It's very much a condition of poverty,” said Professor Majid Ezzati, senior author of the study and Professor of Global Environmental Health at the School of Public Health at Imperial College London, who was speaking at the launch of the review in Geneva. The study, conducted by a global network of physicians and researchers, covered the period 1990-2019. It found that whilst the number of people with hypertension doubled to 1.28 billion, the percentage of people who have hypertension has changed little since 1990. This was primarily owing to population growth and ageing. However, in 2019, over one billion people with hypertension (82 per cent of all people with hypertension in the world) lived in low and middle-income countries. “There are people who have had hypertension for years and decades and they have never had their blood pressure measured because they have not had that opportunity, whereas countries with good health systems do this within,” the report said. Professor Ezzati called it a public health failure that so many of the people with high blood pressure in the world are still not getting the treatment they need. Hypertension significantly increases the risk of heart, brain and kidney disease, and is one of the top causes of death and disease throughout the world. It can be detected easily by measuring blood pressure, at home or in a health centre, and can often be treated effectively with medications that are low-cost.

The study used blood pressure measurement and treatment data from more than 100 million people aged 30-79 years in 184 countries, covering 99 per cent of the global population, which makes it the most comprehensive review of global trends in hypertension to date. By analysing this massive amount of data, the researchers found that Canada, Peru and Switzerland had among the lowest prevalence of hypertension in the world in 2019, while some of the highest rates were seen in the Dominican Republic, Jamaica and Paraguay for women and Hungary, Paraguay and Poland for men. However, success in controlling the disease is “not just an issue of high-income countries”, said Mr. Ezzati, who also listed Chile, Thailand, Turkey and Iran as doing “remarkably well”. Some middle-income countries such as Costa Rica and Kazakhstan now have higher treatment rates than most higher-income countries. These countries have put together “all of the things needed to diagnose people with hypertension, to treat them and to control the conditions, to treat them in a really effective way”, he said, listing universal health coverage, access to health centres, good guidelines, equipment and drug procurement as requirements. Although it is straightforward to diagnose hypertension and relatively easy to treat the condition with low-cost drugs, the study revealed significant gaps in diagnosis and treatment. About 580 million people with hypertension (41 per cent of women and 51 per cent of men) were unaware of their condition because they were never diagnosed. The study also indicated that more than half of people (53 per cent of women and 62 per cent of men) with hypertension, or a total of 720 million people, were not receiving the treatment that they needed. Blood pressure was controlled, which means medicines were effective in bringing blood pressure to within normal ranges, in fewer than one in four women and one in five men with hypertension. “So only 23 per cent of women and 18 per cent of men have control,” said Dr. Bente Mikkelsen, WHO Director, Department of Noncommunicable Diseases. Men and women in Canada, Iceland and the Republic of Korea were most likely to receive medication to treat and control their hypertension, with more than 70 per cent of those with the condition receiving treatment in 2019. Comparatively, men and women in sub-Saharan Africa, central, south and south-east Asia, and Pacific Island nations are the least likely to be receiving medication. Treatment rates were below 25 per cent for women, and 20 per cent for men, in a number of countries in these regions, creating a massive global inequality in treatment. “We need to close three gaps,” said Dr. Mikkelsen. “First of all, there is the gap of getting diagnosed. The second is the gaps to get treated, and the third thing is to get control.” Dr Bin Zhou, a research fellow at the School of Public Health at Imperial College London, who led the analysis, said that although hypertension treatment and control rates have improved in most countries since 1990, there has been little change in much of sub-Saharan Africa and Pacific Island nations. “International funders and national governments need to prioritize global treatment equity for this major global health risk.” The ”WHO Guideline for the pharmacological treatment of hypertension in adults”, also released on Wednesday, provides new recommendations to help countries improve the management of hypertension. Dr. Taskeen Khan, of WHO’s Department of Noncommunicable Diseases, who led the guideline development, said: “The need to better manage hypertension cannot be exaggerated. By following the recommendations in this new guideline, increasing and improving access to blood pressure medication, identifying and treating comorbidities such as diabetes and pre-existing heart disease, promoting healthier diets and regular physical activity, and more strictly controlling tobacco products, countries will be able to save lives and reduce public health expenditures.”.

WHO virtual press conference - Hypertension guidelines and estimates 23 August 2021

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