In 2019, high blood pressure or hypertension caused more than half the cases of coronary heart disease, stroke and heart failure experienced around the world, and more than 10 million deaths. While often causing no overt symptoms, hypertension can damage the function of major organs such as the brain, heart and kidneys, and yet only a minority of patients with hypertension have it under control. The WHF Roadmap on Hypertension aims to support the diagnosis, prevention, treatment, and management of raised blood pressure. The Roadmap is a resource for clinicians, policymakers, patients, and their families. It provides evidence-based guidance and information on epidemiology, emerging technologies, health system strategies, and policies.
With ageing and given our lifestyle and habits, maintaining blood pressure at an ideal level such as 120 over 80 can be a challenge. Hypertension is defined as any blood pressure that is equal to, or greater than, 140 over 90 millimetres of mercury. Primary causes include a high-salt diet, being overweight, excess alcohol intake and inadequate physical exercise; secondary and more rare causes include sleep apnea and conditions affecting the kidneys, adrenal and thyroid glands. More recently, factors such as air pollution, poor housing, traffic, and noise disturbance have been implicated.
Despite a seemingly gloomy picture, hypertension can be managed through a combination of lifestyle adjustments and medications that stave off complications and avert risks to cardiovascular health. A significant challenge in all regions but especially in low- to middle-income countries (LMICs), is raising awareness about the importance of measuring one’s blood pressure and securing access to the range of treatment options.
“Hypertension is a disease of three paradoxes: It is usually easy to diagnose, easy to treat, and easy to control, yet in many parts of the world, it is poorly diagnosed, treated, and controlled. This Roadmap looks at a range of possible solutions to improve the detection, treatment and management of hypertension,” said Professor Prabhakaran Dorairaj of the Public Health Foundation of India (PHFI), and co-chair WHF Roadmap on Hypertension.
Mapping a path to better numbers
A global survey of WHF Members generated 106 responses from 46 countries, with 74% reporting that patients are unaware that they are at risk of hypertension; in LMICs, this figure rises to 92%. Treatment adherence in many countries is also a key factor along with concerns about the lack of awareness initiatives and policies that support affordable screening and medication.
The new Roadmap captures a range of programmes, policies, and campaigns that can effectively address hypertension, along with helpful advances in telemedicine and mobile health. It is one of a series of WHF Roadmaps on Cardiovascular Disease (CVD) that offer an integrated approach to care by drawing on the expertise of clinicians, researchers, allied health professionals, health systems experts and patient groups. This WHF Roadmap on Hypertension complements the recently released 2021 WHO Guidelines on the Pharmacological Treatment of Hypertension which includes evidence-based recommendations on combination therapies.
Effective solutions include policies that emphasise initial screening for hypertension from 18 years of age, and repeated regularly thereafter. Opportunistic screening can also be done in settings such as the workplace, schools, and pharmacies. Strengthening primary care to ensure blood pressure check-ups and follow-up during patient visits should become standard good practice. Home visits and home monitoring by community health workers are beneficial and often necessary, especially in low-resource settings and rural areas that are often far from clinics.
“Screening campaigns are an affordable and powerful tool for raising awareness of hypertension and for early identification. Examples such as the ‘May Measurement Month’ (MMM) have shown that it is possible not only to increase awareness but also facilitate blood pressure measurements in large groups of adult participants and detect hypertension or high blood pressure for the first time in many of them,” said Neil Poulter, Professor of Preventive Cardiovascular Medicine and Director of the Imperial Clinical Trials Unit at Imperial College, London.
Sustaining efforts at prevention and management
Effective management of individuals with hypertension includes non-pharmacological interventions such as weight management, reduced intake of dietary sodium, enhanced intake of dietary potassium, increased physical activity, and moderation in alcohol intake. In tandem, pharmacological interventions may also be required to optimise blood pressure control, as outlined in the recent WHO guidelines.
Population-wide prevention programmes can include salt-reduction strategies and healthy environment policies. Complementary education, starting with guidelines that are easy to understand and follow, will help strengthen patient education, awareness and adherence to treatment. New trials and “areas of interest,” include treatment options in ethnically diverse populations, combination therapy involving different medications at low dosage rather than a single drug, and medications to treat resistant hypertension.
From Kenya and Colombia to India and the Latin America and Caribbean (LAC) region, case studies offer insights into the challenges and approaches to managing hypertension. In a WHO flagship initiative implemented in LAC, more than 50 medications and more than 100 preparations were used to treat hypertension in the primary care setting at the inception of the programme; this is shifting to 7 or 8 core, high-quality medications with 19-20 preparations for use in primary care, with the promise for driving down medication costs across the region. This would be a development in the right direction to alleviate the social, economic and health costs of a risk that is too often ignored and yet avoidable.
Visit www.worldheart.org/hypertension to learn more, and remember to check your blood pressure regularly.