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WHO virtual press conference - Hypertension guidelines and estimates 23 August 2021
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Edited News , Press Conferences | UNICEF , WHO
WHO virtual press conference - Hypertension guidelines and estimates 23 August 2021
STORY: HYPERTENSION GUIDELINES -- WHO
TRT: 02:55”
SOURCE: UNTV CH
RESTRICTIONS: NONE
LANGUAGE: ENGLISH
ASPECT RATIO: 16:9
DATELINE: 25 AUGUST 2021, GENEVA, SWITZERLAND
- Exterior wide shot, United Nations flag flying
- SOUNDBITE: (ENGLISH) Professor Majid Ezzati, Professor of Global Environmental Health, School of Public Health, Imperial College London: “There are nearly 1.3 billion people, 2.8 billion people in the world that have hypertension, and perhaps one of the most important findings is that this is by far a dominant issue in low and middle income countries and in some of the countries in Central and Eastern Europe. It's far from being a condition of affluence. It's very much a condition of poverty”.
- Mid shot, Palais des Nations
- SOUNDBITE: (ENGLISH) Professor Majid Ezzati, Professor of Global Environmental Health, School of Public Health, Imperial College London: “Almost half of them don't even know that they have hypertension, and for many of us and many of you and others, you might be travelling in a country, 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 quite within”.
- Exterior wide shot, United Nations flag flying
- SOUNDBITE: (ENGLISH) Professor Majid Ezzati, Professor of Global Environmental Health, School of Public Health, Imperial College London: Chile has done remarkably well Thailand is doing well in many aspects. Turkey, Iran. So these are the countries that have actually put together all of the things that are needed to to diagnose people with hypertension, to treat them and to control the conditions, to treat them in a really effective way. This includes universal health coverage for people to actually be able to get to a health centre, to have access. Good guidelines, the equipment, drug procurement, all of the pieces. So success is not an issue of just high income countries”.
- Mid shot, Palais des Nations
- SOUNDBITE: (ENGLISH) Dr Bente Mikkelsen, Director, Department of Noncommunicable Diseases, WHO: “We need to close three gaps. 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. And before we haven't been able to look at the full cascade of things”.
- Exterior wide shot, United Nations flag flying
- SOUNDBITE: (ENGLISH) Dr Bente Mikkelsen, Director, Department of Noncommunicable Diseases, WHO: “We have an estimated 1.28 billion adults aged 30 to 79 worldwide that have hypertension, but few have control. So only 23 percent of women and 18 percent of men have control. As I mentioned before”.
- Exterior wide shot, United Nations flag flying
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.”.
Teleprompter
Good day everybody.
Welcome to today's briefing we which is on the embargo on the hypertension guidelines and estimates.
So again, the embargo is until 25 August Geneva time at 30 minutes past midcent, so zero 30 CEST as we still have summertime, so early morning of 25 August is the embargo time.
I hope you all received last minute the preparation material, the press release and the guidelines.
They were only available about an hour ago.
So hence you got them only about an hour ago.
But please have a have a look and if in case you didn't get them, please get back to us.
So I have 3 speakers here with us today from WHO and the Imperial College of London.
So first we have Professor Majid Esati from the Imperial College of London who will outline outline the main findings of the this first comprehensive global analysis of trends and hypertension prevalence, detection, treatment and control, which was led by the Imperial College of London together with the World Health Organisation, which will be published this week in The Lancet.
And then we have Doctor Bente Mickelson who will introduce The Who guideline for the pharmacological treatment of hypertension in adults, which are also thought to be released this week's This week.
The the guideline provides new recommendations to help countries improve the management of hypertension among adults.
We also have online doctor Tuskin Khan who led the development of the guideline who's available for any specific questions further out.
So with this, let me hand over to Professor Majid for the first introductions.
Over to you.
Thank you, Christian, and thank you to all the colleagues who are attending this.
Not surprisingly, these are busy days for health reporters.
So the fact that hypertension is also on the regular screen is a good thing, and for reasons that you will hear from both me and Ante.
So I'll mention in just a few minutes some of the major highlights of what the study has shown.
I'll emphasise that this is a study that has actually involved over 1000 people, 1100 people throughout the world.
We've actually been contributing over the past few years to bring massive amount of data together.
We and cardiac at WHO have been coordinating it, but it's really a truly global effort of scientists and patients.
So hypertension is a major risk factor for a number of diseases, heart disease, stroke and kidney disease.
It's responsible for a really large number of deaths.
[Other language spoken]
The question is that are we dealing with this?
And so the study brought a lot of, you know, much data data measurements of blood pressure on well over 100 million people over the past three decades together.
What it has shown as a highlight is that there are adults between ages of 30 and 79 years, which is really the ages that are often subject to to particular treatment guidelines.
There are nearly 1.3 billion people, 1.2 million, two point 8 billion people in the world that have hypertension.
Perhaps one of the most important findings is that this is by far a dominant issue in low and middle income countries and in some of the countries in Central and Eastern Europe.
It's far from being the condition of affluence, it's very much a condition of poverty and and so there is massive global inequality.
And if you would like during the question.
We can get to that.
Just about half of those people have have ever been diagnosed with hypertension.
So, so, so almost half of them don't even know that they have hypertension.
And for many of us and, and many of you on the other, you might be travelling in a country.
There are people who have had hypertension for years and decades and they have never had their blood pressure measure measure because they have had, they have not had that that opportunity.
Whereas countries with good health systems do this quite routinely, more than half of the people are not receiving treatment.
And I emphasise here that we started treating blood pressure in, in better off countries with the good health system in the 1980s.
So, so many of the large randomised trials were done in the 1970s and it's not since 1980s we have been treating them.
So, so it's a major shortcoming of, of our health systems and our, and our and our and, and the financing of it that, that over 1/2 of people are not being treated.
And again, that's by far higher in, in lower middle of countries.
This has been so far the bad news.
So let me get to the good news.
And that may well be a great way for, for, for how then they can pick up on the new guidelines.
Is that so there has been major, major improvements in some countries.
Some of these are our countries that are, that are higher income, better off industrialised countries that have had the resources and put the resources into it.
Canada, Germany and South Korea, Republic of Korea have been remarkable.
They're actually together with Iceland, they are the global leaders.
But there are also a number of middle income countries and these are spread throughout the world that are doing remarkably well.
The press release highlights 2 of these, Costa Rica and Kazakhstan, but actually there are a number of others.
Chile has done remarkably well.
Thailand is doing well in many aspects.
[Other language spoken]
So these are the countries that have actually put together all of the things that are needed to, to to, to diagnose people with hypertension, to treat them and to control the conditions.
So to treat them in a really effective way.
This includes universal health coverage for people to actually be able to get to a health centre, to have access to positions, good guidelines, the equipment, drug procurement, all of the pieces.
So so success is not an issue of just **** income countries and many medium income countries have achieved.
So I'll end by saying that, but the poorest parts of the world, so, so many parts of sub-Saharan Africa are parts of South Asia, some of the Pacific island nations, they are still not actually getting the treatment that are needed.
So in an era that we are focusing a lot on equity and treatment and, and again, this is something that we have been hearing every day for the past year and a half in equity, in, in, in diagnosis, equity in treatment.
This is again something that as a, as a global health community, we need to be aware of.
So with this, I would stop now.
I'll let Ben to talk about the guidelines, which is a really important piece of, of actually bringing this equity.
And then I look forward to the questions that that you may have.
[Other language spoken]
I guess that needs no further introduction for you, Bente.
So over to Doctor Bente Mickelson, please.
[Other language spoken]
Thank you very much, Christian, and especially, of course, a huge gratitude to Professor Majid and colleagues who has published this extremely important paper.
So I, I want to sort of emphasise a couple of things that machine has already talked about.
First of all, we know that cardiovascular disease is the leading cause of that's in the last global health estimates.
We know that 17.1 million people are dying from cardiovascular diseases every year and we know that hypertension is the main reason among those.
So that is very important.
And as we saw, the study is the, the study from The Lancet is the first comprehensive global analysis of trends in hypertension, both prevalence detection, treatment and control among adults 30 to 79 years.
And the data is from 184 countries.
So this gives us a very, very good background.
And as you have seen from the press release and also from what she is saying, is that the number of people with hypertension has doubled since 1990 to 626,000,000 in women and 652,000,000 in men in 2000 and 19.
And I think what I would like to use as a starting point is that we need to close three gaps.
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 controlled.
And before we haven't been able to look at the full cascade of things, which is the new the new sort of background for the the guideline as well.
And if I would like to add other things that is really showing the challenges, the huge inequities that Machine was also speaking to.
But if I if I could sort of comment on the on the three gaps first.
So we know that globally 50% of women and or 60, close to 60% of women and close to 50% of men with hypertension has got their diagnosis.
So meaning that four in 10 of women and close to 50% of men they undiagnosed.
That is the first gap that needs to be closed.
And of course that gap needs to be closed both by strengthening the health system by including cardiovascular disease and hypertension into UHC.
And it is of course completely dependent on capacity building and and and capacity and competency among healthcare workers as well.
The second gap is the treatment.
So at the moment we know that 47% of women and 38% of men were treated respectively.
So again meaning that half of the women get treatment and four in 10 men get treated as well.
The more important fact from this study is that even if you get treated, the control, the management of of the disease itself is very poor.
So the control rates among people with hypertension is only 23% for women and 18% for men.
And of course, as usual, we see huge inequities.
So in **** income countries we have seen an improvement of the full cascade while in low income countries it is really very alarming.
Coming back to that, this is one of the most deadly diseases.
So if we look at control rates in in in Africa, Central and South Asia and and some of the Eastern European countries, we see that they are as low as 10% for women and men in these countries.
So these are really areas for improvement and that's why we believe that the new guideline that also give clear sort of algorithm on how to treat is so important.
We have seen of course treatment and control rates improving since the 19 nineteens.
So we can learn from the countries that has made improvements and that is of course also very important as part of the background.
So if I move now to speak a little bit about why the improvement has come, the expansion of UHC coverage and strengthening of primary Healthcare is of course a major factor, but it's also the factors as improved diagnosis and guidelines that recommend progressively lower thresholds.
And also it's worthwhile to know, worthwhile to know that the the treatment in this case is basically off patent drugs and there should be no reasons why there should not be access to these to these drugs.
So we have talked about the figures and we know that we have an estimated 1.28 billion adults aged 30 to 79 worldwide that have hypertension, but few have control.
So only 23% of women and 18% of men have control.
As I mentioned before, when it comes to the detection, we know that this can be be detected in community and primary care facilities and there is, as I already mentioned, a number of effective drugs available at relatively low costs.
So when we worked for 1 1/2 year on the guidelines, this was an important background and the background has been strengthened by Majid's paper, you know, the whole cascade.
So there is opportunities now to address all the three gaps, both the gaps in diagnosis but also the treatment and the control rates.
And by doing this, we think there is also so huge possibilities to save lives and to to reduce the inequities.
Of course, as we all know, COVID has made an extra toll to the whole picture of non communicable diseases in general.
And of course, since hypertension is one of the major diseases, we have seen huge disruptions.
So the management of hypertension has been reported to be disrupted in 30 six of the countries in the latest post survey that double HO has done.
So I will now go more a little bit into the details what the the guideline is.
So the guideline is the first in 20 years.
So it's really on **** demand.
It's one of the most demanded guidelines from all countries.
And the new publication provides evident based recommendation for the initiation of treatment of hypertension, enables and also recommended intervals for follow up.
The document also include target blood pressure to be achieved for control and information on who in in the healthcare system can initiate the treatment.
The guideline provides the basis for deciding whether to initiate treatment with monotherapy with a single drug, dual therapy or single pill combination.
This is very important because as we saw in the previous figures, adherence or the, the, the, the compliance to the treatment, it's of course necessary to have control of the disease.
And the guidance is also guidance for countries selecting medicines and algorithms for hypertension control for the national guidelines for hypertension management.
When you look at the guideline, it is technical, it is for clinicians and healthcare providers at all levels of health cares.
But also we believe that the audience is very much the national NCD, cardiovascular programme managers, healthcare academics and policy makers because by closing these three gaps, there is a huge possibility to save life and also to provide less morbidity from hypertension.
The new guidelines also include sections on COVID and hypertension and pregnancy and hypertension.
Although several countries and professional society have guidelines on topics or hypertension, these are more.
[Other language spoken]
To the population.
These are more specific to the population and the particular country and the specific setting.
Last but not least, I would like to also make a point that this is supplementing all the work that Double HO is doing with partners.
And I'm sure that on the On the World Heart Day, which is coming up very soon, we will see the full spectre of interventions possible.
So we have this as a supplement to the double HO package of essential NCD interventions known as the pen package.
And and now this guideline is also including the recent advances in pharmacological treatment.
Very important.
The double HO essential medicine list identifies all classes of anti hypertensive drugs mentioned in the guideline.
And in June, the essential medicine list also included single ping combination medication for hypertension and this further support the evaluation of all classes of anti hypertensive drugs as well as single pill combination of this current guideline.
So with the guideline and with the double HO essential medicine list, it will be very huge possibility for countries to accelerate the the treatment and the control of hypertension.
So I think I will stop there and we have capable people online.
So Doctor Tuscan Khan will be very helpful if you have specific questions about the guideline and the different medication and and also the the, the control thresholds and so on.
[Other language spoken]
So thank you very much, Doctor Benton and Professor Majid, for for these intros and in order not to raise the tension more, I'll go down the list of the question.
I see Christiano from DPA has already raised her hand.
And for the others, please raise your hand if you want to go into the the queue.
Of course, Christiano, over to you.
Thank you, Christian, for taking my question.
Here's one just to understand the, the, the figures here.
How, how would you know that in 1990 there were only half as many people with hypertension?
I mean, I guess in 1990 this just wasn't measured very much in a lot of countries.
But my quality question is this one.
Can you explain in medical but laymen lay women's terms what's actually wrong when someone has hypertension and is this a lifestyle question?
Is it possible to to remedy to that without taking medication but changing one's lifestyle?
[Other language spoken]
Indeed, very important question because the drugs we all know, yeah, I think for the for the measurement and all these details.
Let's start with Professor Majid.
Sure, Thank you.
That's so Christian.
Thank you for the questions.
Both of them are very good questions.
So in terms of what we knew about 1990, we didn't just take measurements that were done.
Actually all of the data sources that were that were used and these were very carefully screened by like by a very large number of people were, were studies that had to use the jargon.
And then I'll say what these are called population based.
So these were the studies that actually took a random sample of the population and went and measured them.
So regardless of the whether the person had been diagnosed beforehand or not, those studies, those data measured them.
This is a tradition of surveillance that has been in place actually in some countries since the 1950s and 60s, but it became actually really widespread starting starting 1980s and 90s.
So literally every region of the world has been doing this more recently.
Since after 2000, WHO has been leading the step surveys.
But even before that, there were international bodies or, or academics or physicians that were doing these random samples.
So, so this is the sort of the true estimate rather than the ones that happened just to have gone to the doctors.
And, and again, you know, Chile has started doing this in the 1980s, Thailand has started doing it much earlier, Iran, so many countries, many medium income countries, India started doing it in 1970s and 80s.
So, so many countries were doing this random samples.
So this is this is AI guess what we call an unbiased estimate.
I'll give a shot at the second question of lifestyle, but but Bendy can also add so, so I think we tend to actually create a role for public health.
Public health being the health system in generally beyond the individual.
Obviously individuals make choices, but they make their choices in, in a context and, and I want to in the case of hypertension, highlight two or three things that are really important.
So, so one is the role of fruits and vegetables and I'll come to solve so, so this is diet.
So, so when I live in London or in Geneva, you can actually walk into a store any time of the year and buy fresh fruits.
Fruits are no longer seasonal and we generally, at least as professionals can afford them.
[Other language spoken]
Maybe the taste of strawberries isn't as good as good in winter, but what we can get.
And whereas for much of the world that's not an option, fruits and vegetables are either unaffordable or are actually for much of their unavailable.
And actually they are a very good source of of potassium that lowers blood pressure, similar things with salt and sodium.
So again, yes, sometimes people add it at home, but a lot of times this is in food that's prepared in, in the wealthy world that prepared food in is industrialised in low income countries that may not be as industrialised, but nonetheless as salt and, and more so actually there is and there is, there are good studies on this, that that refrigeration, which means that people don't need to use salt to preserve their food, reduce the salt.
So, so again, this is not something that people make a choice not to have a refrigerator and have to use salt to, to preserve the food.
It's actually something that is a part of the broader development.
So, so, so, so yes, there is an individual choice, but there is a major choice for, for things that are either broader sort of development of, of, of, of a society or things that are in the hands of regulators and policy makers to be able to do things and, and, and through fiscal policies or regulatory policies.
And certainly on the on the prevalent side on how much hypertension there is, that's where we want to focus their attention.
[Other language spoken]
Thank you, Professor Majid.
And I'm looking also at Doctor Bente because as we're giving out The Who guideline for the pharmacological treatment, the obvious question is what else can they be done?
[Other language spoken]
So of course today we are talking about very much the the the three gaps, first of all to get diagnosed and the second to get treated and the third very important.
It's also to get control that doesn't diminish as Macheed also mentioned to address the modifiable risk factors for hypertension.
So that is extremely important.
So we know that unhealthy diet as was mentioned all by fruit and vegetables, physical inactivity and double HO just came out with global guidelines on this and a strategy consumption of tobacco and alcohol.
Also a well controlled diabetes being always an obese comprehensive treatment plan must include all of this otherwise we are not doing our job.
So these are extremely important population based interventions, taxations, access to healthy food and so on.
Today we are sort of focusing on the people that already have hypertension which is undiagnosed diagnosed.
And this has been a very important missing piece.
And it's possible now because we have low cost pharmaceutical products and we are able now to set out both sort of at which level we need to start treatment, who can treat with what in what sequence and what is the what is the medicines that is needed.
So this is what we are talking about today, but that doesn't mean that we are now diminishing the focus on the modifiable risk factors.
That's very important.
Thank you very much for the question, Christiana.
[Other language spoken]
And I'll also bring in Doctor Tuskin Khan, who again led the development of the guidelines.
But to maybe give a bit of a definition or a clarification on what hypertension is Tuskin?
Sure, thank you.
What is hypertension?
Blood pressure is the force exerted by circulating blood against the walls of the body's arteries, which are the major blood vessels in the body.
And hypertension is when this blood pressure becomes too ****.
[Other language spoken]
The 1st is the systolic number, and it represents the pressure in blood vessels when the heart contracts or beats.
And the second number, the diastolic number, represents the pressure in the vessels when the heart rests.
And so hypertension really is a chronic condition where we're putting too much of pressure on the blood vessels in the heart.
[Other language spoken]
That's an important definition on the way.
[Other language spoken]
And next in line is Lisa, Lisa Schlein from West of America.
[Other language spoken]
[Other language spoken]
Nice to see you.
I have a couple of questions here in in regard to the lack of diagnosis and treatment primarily in the poor countries in sub-Saharan Africa, Asia and so forth.
Why are they not getting diagnosed?
Why are they not getting treated?
Is it largely a matter of poverty or is the is it also a matter of lack of information that people simply are not educated into, you know, understanding possible symptoms or even among the health, the people, the doctors, the health workers who may not be well informed in regard to hypertension?
And then by how much our lives shortened people who have **** blood pressure.
And if they don't do anything about it, how how many lives are lost in this regard?
And also you say you have affordable medicines.
How how much do low cost effective medicines?
I mean, what are the costs of low of?
[Other language spoken]
[Other language spoken]
Mangling everything, right.
[Other language spoken]
And then sorry, just lastly, I missed the number of people who were actually studied for this.
[Other language spoken]
Right.
So I have a big round of questions.
So I think everybody's concerned with this.
I'll, I'll start just again with Professor Majid and then go to the round and come to all of your friends and ask you.
Thank you, Christian, and thank you, Lisa, for, for, for again, very good questions.
I'll, I'll start with your last question and then and then I'll sort of attempt for some of their dear ones, But but again, I'll leave them for, for Ben 10 and the scheme.
[Other language spoken]
How many people were studied?
So the data were on about 104 million people.
And so again, these were, these were over a period of 30 years, random samples of a population.
So, so in the UK where, where I live in, in England, in England for a week, it's done.
So in Scotland there is something called health survey for England.
So, so each year a number of people are contacted by random people and they're asked to, to, to undergo a medical exam.
And that gives the picture of the population in this country.
And this is done systematically across the world.
It's been going on in places like Japan and the US since 1960s, systematically elsewhere more recently.
So when you add up all of the people who were participating in this for 104 million people measured over 30 years, we brought all of this data together and told the story.
And then on one reasons for under diagnosis on the treatment again, I'll give a short answer, but I think it's something that really have been the skin would have probably more systematic things to say is that it's a combination.
So I think a part of the, a part of the story is, is under resourcing, a part of it is for individuals if they have to pay out of pocket.
A part of it is for the health system.
If, if the health centre is not there, if the equipment are not there, if, if the drugs that are needed are not there, they're not procured on a regular basis.
But again, there are other things that sort of become more subtle.
There was a, there was a story in one of the big the Guardian here that sort of almost brings tears to your eyes, which is that look, somebody who, who is, who's a driver, who is paid by the hour.
And this is, this is in London.
This is not in a good place who by taking time off work, they would not only lose that days pay, but they would be fine for not doing deliveries.
They started skipping their, their, their appointment.
So, so I think it's under resources and, but in, in a financial way, but also in lack of ability to be able to use the health system.
And, and actually, arguably countries that have done really well in this have found ways to get around some of these.
So even if they haven't changed the entire economic system, they have made it a lot easier for people to be, to be measure, to be, to be diagnosed and, and to actually have access to a medicine.
So if they couldn't go to the pharmacy, a health worker might be actually coming and checking on them.
And, and there is text messages.
There is all kinds of techniques that in various ways work.
And, but I think the last thing I'll say on this is that I think the other thing that that emphasising a condition does and guidelines are a way of doing this is that it changes what you might call clinical culture.
So, so, so there was a time that that physicians wouldn't be paying attention to certain conditions, but there was a time physicians and other health workers, there was a time that just because they're in the guidelines, that's in their training, they actually pay more attention to it.
So it's not completely lack of knowledge, but it's the way that we practise.
And similarly for patients when I move from from actually one country to the UK and then the other country, every time I saw my physician, even if it was for a shoulder pain, they would measure my my blood pressure to here.
I was shocked that the first time they were measuring when I went there.
So, so I think it's that sort of idea of culturing patients and in and in and in physicians.
All of those actually help.
But resources are a big part of this over.
Yes, I cannot speak if I'm muted, that's correct.
So thank you very much, Professor Majid, and over to and on very early also the what does it do on the on the lifespan and the costs of of medicines of treatments courses?
[Other language spoken]
Thank you again for absolutely great questions.
So again, you know, when it comes to the lack of diagnosis, it is of course all the things you mentioned it as we know hypertension is before it gets severe, very asymptomatic.
So both the person itself, the population need to be health literate to understand that this is one of the most dangerous conditions and it is possible to control.
So that is a message that we need to with the support of all of our partners to get disseminated again and again.
And it is of course, a time for thoughts because when we see a virus and the focus that we can and need to of course, put on virus, we need to also have a similar very much attention to the deadliest diseases.
And hypertension and cardiovascular is the deadliest disease.
And of course, we need to also understand that, as Tuscan said, that this is the disease to the heart, to the brain, to the kidneys.
So it's not only a blood pressure, it's a systemic disease.
So both the population need to have health literacy, be educated, but that goes also for of course the capacity in the healthcare system and the structure of the healthcare system.
And I think the guideline will help us a lot when it comes to that because one of the recommendation is who can make the diagnosis and, and screen and who can treat.
And you can see from the guideline that that can be done also by nurses at community level with the oversight of a protocol, of course, developed by the OR adopted by the the government.
So this is very, very important.
So the weak health system, even if the medicines is cheap, we can see that there is a lack of access.
It's a lot of mark UPS people, since it's not included in universal health coverage many, many places, it is an out of pocket cost.
That means that people need to pay for the whole medicine themself.
So this is also very important.
So health system strengthening, you could call it also resourcing, capacity building, health literacy.
So that's for the diagnosis.
But in this study, which we are discussing today, we know that close to 50% of the women that is diagnosed with hypertension is on treatment and only four in 10 men is on treatments.
So we also have an opportunity to really address those already diagnosed.
That's very important.
And even more important is the third gap that we have discussed here, that the control rates among people with hypertension were 23% in women and 18% in men.
So women, 4IN men, women and two out of 10 in men got controlled when they had got their diagnosis.
And we believe that the new guideline will really support to close this gap.
So if we think on the whole discussion we have, we are having today with the strengthening of the health system with access to medicine will be triggered also by this guideline because it will be obvious that it is possible to treat hypertension.
And of course, granted, as we discussed, but today we're talking about the treatment, it was also a question about costing.
So when we have developed these guidelines with also recommendations of algorithms for treatment, it is of course absolutely possible to do investment cases for this.
We know that the treatment is cheap, it's low cost medicines, but there is a need to include them in the UHC.
So this is not a cost for the single patient and their families.
It has to be covered by the insurance system.
I don't know, Doctor Khan, if you want to add something on this.
[Other language spoken]
They did quite adequately.
Thank you very much, all, all three of you.
And I understand it's difficult to put the dollar cost to it because that's very different on depending on the drug, the treatment, of course, in the country especially I could imagine because I know that's something that Lisa is always interested in.
Is, is there any way to put a cost to this?
Benton, maybe we're on mute.
Doctor Benton, please.
[Other language spoken]
Whether whether, yeah, sure, whether it's possible to put a dollar cost on the treatment that might be, I know I can imagine it's difficult with the region and the treatment and the different drugs.
But is there any estimate for the health system to say that that's for the hypertension patient costs so to say?
So that will be absolutely possible will with algorithm treat algorithms guidelines and also with the figures that we have.
We cannot present a figure just now, but this will be absolutely possible and will be part of the implementation of the guidelines in the regions and countries as well.
Thank you very much, Benton.
I don't know if doctor Professor Macheed wanted to add something.
I saw your hand.
[Other language spoken]
Just very briefly question.
So, so I don't have a number for cars right now, but but I, I do say, I can't say that that an exercise called Disease Control priorities, which was also a large exercise.
I wasn't involved in it but but I was an observer of it actually considered hypertension treatment as one of the most cost effective interventions.
That would be done across the world.
It has to be financed.
But again, you know, it's it's it's not a surprise to any of the media colleagues and the briefing that that the issue of financing of global health is right front and centre and and WHO has been taking a leadership role that look, this should happen people people should be entitled to a basic minimum and hypertension treatment was one of them.
There is an update process of this in the case of the in what will be in the next year WHO road map to to sustainable development goals for non diseases, what the exact costing is.
But I think however you do the number with with with modest financing that in middle income countries can be largely domestically financed.
And perhaps to develop an assistance, it would be something that would that would be on the list of things with money.
And thank you very much.
And the cost effectiveness being maybe the most important for our for our health system because that's what guideline developers and politicians are looking at.
Yes, thank you very much.
Lisa, I see your hand is still up, but I'm going first to Peter Kenny in case you still have a hand.
OK, a follow up as you've been on I.
[Other language spoken]
[Other language spoken]
[Other language spoken]
First of all, it's an old question that I asked that wasn't answered.
And that is how many year, years of life are lost due to if you have an average due to hypertension.
And then a couple of extras is obesity is a of epidemic proportions in the United States and other wealthy countries.
I don't know if that's also the case in the poorer countries, but and and yet the rich countries seem to manage to bring down the cases of hypertension.
Is that because they're being diagnosed and taken care for that?
And is obesity also a problem in the developing countries?
And then lastly, and and I'll jump away, is according to your statistics, women seem to be doing better in terms of getting diagnosed and treated for their hypertension than men.
Why is that?
Is that because they are more concerned about their health they they sort of under or maybe less afraid to go to the doctors than men?
[Other language spoken]
Yeah, 3 interesting questions.
So yes, we didn't quite solve the years lost yet.
Maybe we start with this looking, looking into the virtual room here.
Maybe we start with end with Professor Majid on the on the years lost.
And then we'll, we'll look to see if there's any data on the gender differences on, on the yeah, yeah, on the, on the regional country or cultural differences differences.
Over to you.
[Other language spoken]
So listen, I'm sorry, I missed the years of life question.
So, so I don't have an answer to exact years of life, but, but I do have an answer that, that various people for various years have made estimates of how many deaths are being what you would call brought forward by, by **** blood pressure.
Ours was sort of just just about 8 million.
But, but you know, it doesn't matter what source we look at, you're looking at 78910 million deaths and each year that are happening earlier than they would have.
I, I, I can't put the number of, of, of what those years are, But what I can say is that those that are happening at a much younger age in non middle income countries than in **** income countries.
So, so whereas in **** income country in, in parts of the Pacific, in, in Europe, in the in, in North America, it may be people in the 80s or or perhaps in the 70s, none of us dying earlier.
Elsewhere, it may be people dying of kidney disease or stroke in their 50s and 60s.
So again, there is an inequity even in the years of life last disfavouring low income populations.
And obviously questions, you're absolutely right is a major risk factor for it.
But but again, the other things that have changed in **** income countries are a number of other things that affect blood pressure.
[Other language spoken]
So that includes an and this is well documented.
The substantially higher intake of fruits and vegetables, and this is perhaps too many calories, but more from fruits and vegetables.
There is somewhat lower salt and, and then there is much more subtle thing.
So there's actually moderately good evidence that when you introduce central heating, blood pressure goes down.
So it's actually housing quality and, and it affects winter blood pressure.
And there are very good studies comparing let's say northern China and southern China and what the effects are where heating isn't as good.
So, so all of these things have sort of been interplaying with obesity that have lowered even the level of hypertension, not to mention it's treatment and some of it is unknown, but these are the things that we believe must matter.
And then on the gender question, so I should say I can't answer why it is because it's outside of my field.
I do know that there is a literature on gender differences in seeking care and access care and and in fact, one of the things that some of my colleagues are starting to look into is both the level of the disease and its care, looking at the gender differences that that are happening and trying to understand it.
So it's a very good question that I'm afraid I don't have the answer to, but I think there is a community out there that that is specifically asks the gender question and how those may be more aware.
Thank you very much.
[Other language spoken]
Let me look at this Doctor Taskin maybe first to see if there's any data on that or what what do you have about it?
Over to you.
As Professor Isati alluded to, we have noticed disparity not only in hypertension but just in men seeking care in general for treatment, particularly of the chronic diseases.
And we can allude to some of the factors, but we don't actually have more anthropological and social information on it.
In a lot of places, men are still the breadwinners and so access to the healthcare system often for a day can can be some of the issues around it.
Similarly say it kept seeking behaviour has been identified and also a host of other sociological issues.
So we can sort of point to what the reasons are, but we haven't actually done a study to determine what exactly the the true causes of the disparity is.
[Other language spoken]
Thank you very much.
The ski documentary, anything to add?
Yes, thank you very much.
So thank you for highlighting as well obesity as a risk factor.
I mean this is really the the tsunami of the risk factors and the member states are fully aware.
So they have asked double ho to develop recommendations and maybe also treatment targets for obesity.
So there will be a paper discussing this for the first coming executive Board and World Health Assembly in 2022.
This is widely recognised and there is a urgent need to come up with recommendations on this, on the on the sort of the the saving life component.
What we know from the latest global health estimates is that ischemic heart disease and stroke is the major leading cause of deaths.
So we had the latest figures from 20/19 shows that 17.8 million people are dying from cardiovascular diseases every year.
So it is the major leading cause of that.
We don't have hypertension as a measure in this specific global health estimates, but we have absolute reasons to believe that that is again the underlying cardiovascular disease, disease to put or condition to put it like that on the gender dimension.
This is extremely important and we have double HL regions that has addressed this in in more detail.
So especially the Euro region of double HL has a men health strategy and this was exactly because they were recognising that they had an improvement of cardiovascular disease in that region except for men.
So they were actually addressing the missing men and this is what Doctor Khan is saying as well.
It's a mixture of health seeking behaviour but also risk factor behaviour which is actually different unfortunately between the gender.
So we are more and more at adding granularity to the data we provide from Double HO because there is a need to look into different dimensions.
We mentioned earlier today that what is grave in the results from Machid study and Imperial College study is of course the inequity between **** income and low income countries.
[Other language spoken]
The last point is that I want to re emphasise what Machid was saying that some of you would know that we have a menu of interventions policy options that has been developed since 2013.
It was updated in 2017 and we will do a new update now in 2022 and this is called the Best Buy.
So this is affordable interventions and that is a very important guidance for countries overall when they want to address non communicable diseases.
So it goes without saying of course that we are also looking into hypertension and hypertension treatment in that perspective.
So that will come out next year from Bubble HO.
[Other language spoken]
Thank you again all very much.
Now, luckily, with all these massive answers on the questions of Lisa, we still have time for Peter, Kenny.
[Other language spoken]
[Other language spoken]
I'm just wondering about this percentage factor in hypertension because the numerical number of people with hypertension has risen astronomically, but the percentage hasn't changed since 1990.
But also the perception of hypertension as being rich persons or people's disease is, has also changed, I think.
So can you say that the OR are you concerned that global health systems or countries health systems are paying enough attention to hypertension?
And I'm also interested in the factor of stress in hypertension too.
[Other language spoken]
Peter, can you repeat the last?
You're also interested in the role of stress in hypertension, of course.
[Other language spoken]
Yes, thank you very much.
Yeah, on the percentages, maybe we start with Professor Majid again.
Thank you, Peter for again all very good, good questions.
So on the percentage versus absolute number, I suppose you can think of it as, I'm not going to use the example of pie or cake or pizza in a hypertension briefing, but sort of a big something around that you're making that overall, I'm going to say pie, but Magic doesn't have a lot.
[Other language spoken]
[Other language spoken]
[Other language spoken]
[Other language spoken]
OK, sorry, I don't know how I got muted it.
So, so, so just imagine that you have a sort of a pie and you're making the whole thing bigger or smaller, but you're also taking the slice a particular size of a slice of it.
So the slice is the percentage and, and the size of the pie is the population of the world.
And, and so, so, so we are taking the same percentage, but we live in a world that has many more people in it.
And actually people have that has been ageing is a good thing in some sense because people are living to older ages.
[Other language spoken]
And, and on the issue of, as you mentioned, the disease of being for poor versus rich, I think one of the things we really hope that this, this is study and similar ones that we have done with colleagues that what you show does it takes away what's really an assumption increasingly not the perception that these are issues of, of affluence.
These are completely issues of poverty.
There are issues of poverty within **** income countries.
So, so all around Europe and and America, the poorer people do worse, but they're also globally a situation of poverty.
It's because it's just very expensive to have a healthy life and expensive for individuals and expensive for societies.
And then and the sort of equity inequities that we are seeing just cut across everything.
So, so, so to eat, to eat well and and healthy, it's expensive.
So I think so yes, the, the balance has shifted as the sort of things like healthier foods have become affordable for wealthier ones.
And not on the stress one.
I know that, I know that it's something that we hear all the time.
As far as I know and, and, and I have very limited knowledge on this, The actual epidemiological evidence of the line is not very strong, but, but I don't know much about it.
So, so, so in many ways that the short term stress may be, may be a marker for longer term phenomena that affect blood pressure.
But it is really something that that that, that I know a little about other colleagues, again, the scheme who also has a clinical background or Vente may know more about the stress.
And, and if they do, I think you should definitely take that.
Thank you very much, Professor Majid.
And that's here.
Bente knows more about stress.
[Other language spoken]
So I think I would leave that question to Tuscan because I don't have any sort of facts present.
Of course, it's easy to say yes, but Tuscan, maybe you have some more specific knowledge about this.
[Other language spoken]
So when the body experiences A stressful situation, there's a surge of hormones, and these hormones actually temporarily increase your blood pressure because they cause your heart to be to burst faster and your blood vessels to narrow.
But largely in the epidemiological studies, there's no proof that stress by itself can cause long term hypertension.
The thing about hypertension is that there's no single cause for it.
And so there are a lot of different factors, some mentioned earlier like obesity, like tobacco, like unhealthy diets, genetic factors, etcetera, that actually cause hypertension.
But of course, in these days when we experience a lot more stress, when we work a lot more, when we have a lot more meetings, etcetera, it's become a prevalent part of our lives.
And with time we will see the actual impact.
But for now, there isn't clear conclusive evidence that stress actually itself causes hypertension.
[Other language spoken]
Thank you all very much.
And yes, an interesting point because in society, stress, I think it's very much related to hypertension, not only to tension, but the hypertension, right?
I'm looking around and I don't see any more hands and we're exactly at the hour more or less.
So with this, I thank you all very much.
Of course, all the media colleagues attending on this very important topic.
And one of the first estimates.
So again, thanks to Professor Madrid Asati, professor of global health and my global environmental health at the School of Public Health at the Imperial College in London, Doctor Bente Mickelson, director at the Department of Non Communicable Diseases at the World Health Organisation and Dr Tusking Khan, medical officer at looking at the cardiovascular diseases at the Department of non communicable diseases at The Who.
So happy if you can all.
If you all have further questions on this, you see at the press release the contact details for Alison.
Thanks to Alison Pudnier for putting all this together.
Bent, I think just put into the chat two more links which you all can have a look at the embargo of this one.
Now here again to remind is Wednesday early morning, Geneva Zero 30, so 12:30 early Wednesday morning.
Thank you all very much and have a good day.