Still on the Road to Worldwide Hypertension Control

Abstract

Article, see p 441 Raised blood pressure (BP) is the leading preventable risk factor responsible for disease burden in high-, middle-, and low-income countries and was responsible for ≈9 to 12 million deaths worldwide in 2013.1 However, raised BP is chronic and almost always asymptomatic, thereby making it low priority for health systems, providers, and patients. Estimates of global and regional mean BP benchmark temporal trends in raised BP-related risks and demonstrate the potential public health benefit of shifting populations to healthier BP distributions.2 However, these estimates are not immediately relevant to current clinical practice, which is focused on eliminating above-threshold raised BP, that is, hypertension. Antihypertensive medication treatment lowers stroke risk by 35% to 40% and coronary heart disease and heart failure by 20% to 25% among hypertensive patients, so the case for identifying, treating, and controlling hypertension is founded on strong evidence and should be a top public health priority.3,4 In this issue of Circulation , Mills et al5 use data from 135 population-based studies representing 90 countries to estimate the global, regional, and country-level epidemiology of hypertension and hypertension awareness, treatment, and control. Measuring BP to detect hypertension, and then treating it, seems simple to us and in fact has been the bread and butter of routine medical practice for generations of healthcare providers. It is therefore sobering to learn that in low- and middle-income countries (LMICs), the epidemic of hypertension appears to be growing (7.7% increase in age-standardized adult prevalence …