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International Society of Hypertension

WHL & ISH Hypertension Fact Sheet

The World Hypertension League and International Society of Hypertension have just launched a Fact Sheet on High Blood Pressure: Why Prevention and Control are Urgent and Important. Read on to view this document.

Click here to download the Fact sheet as a PDF document.  

                                    

High Blood Pressure: Why Prevention and Control are Urgent and Important. A 2014 Fact Sheet from the World Hypertension League and the In ternational Society of Hypertension


Increased blood pressure is the leading risk factor for death and for disability globally

according to the World Health Organization Global Burden of Disease Study(1).

 

Increased blood pressure was the cause of an estimated 9.4 million deaths and 162 million years of life lost in 2010 and the cause of (2-8)

  • 50% of heart disease, stroke and heart failure.
  • 13% of deaths overall and over 40% of deaths in people with diabetes.
  • Hypertension is a leading risk for fetal and maternal death in pregnancy, dementia, and renal failure 

Hypertension is a public health epidemic (2;9;10)

  • Approximately 4 in 10 adults over age 25 have hypertension and in many countries another 1 in 5 have prehypertension.
  • An estimated 9/10 adults living to 80 years of age will develop hypertension.
  • One half of blood pressure related disease occurs in people with higher levels of blood pressure even within the normal range.

Hypertension now disproportionately impacts low and middle income countries (2)

  • Two thirds of those with hypertension are in economically developing countries.
  • Heart disease and stroke occur in younger people in economically developing countries.

Blood pressure related disease has a major impact of health care spending (11)

  • An estimated 10% of the health care spending is directly related to increased blood pressure and its complications. 
  • The costs are estimated to be just under 25% of health care spending in Eastern Europe and Central Asia.

The behavioural factors play a major role in increasing  blood pressure (12)

  • Unhealthy diet is estimated to be related to about half of hypertension.
    • About 30% related to increased salt consumption, and about 20% related to low dietary potassium (low fruit and vegetables).
    • Physical inactivity is related to about 20% of hypertension.
    • Obesity is related to about 30% of hypertension.
    • Excess alcohol consumption also causes hypertension.
    • Being tobacco free is especially important for people with hypertension.

Clinical interventions have not been systematically applied in both economically developed and developing countries (2;13;14)

  • Most individuals with hypertension are unaware that their blood pressure is high.
  • A large proportion of those who are aware that their blood pressure is high remain untreated and even when treated, a large proportion still have sub-optimally controlled blood pressure.

Investments in prevention are often cost saving (15-19)

  • Policy interventions at a population level to improve diet and physical activity are often cost saving and allow people to make healthy choices.
  • Recommended polices to prevent or manage hypertension through improved diet and increased physical activity are outlined by the World Health Organization (WHO).
  • The United Nations has agreed to a 2025 goal of reducing hypertension by 25% and dietary sodium 30%. 

Investments in Treatment and Control are cost effective if targeted to those at higher risk (20;21)

  • Most people with clinical hypertension have additional cardiovascular risks and or evidence of blood pressure related damage (heart disease, stroke, kidney damage).
  • Treating increased blood pressure in the range defined as hypertension (> 140/90 mmHg) is effective in reducing stroke and heart disease.
  • Managing increased blood pressure in those at moderate to high risk of hypertension is cost effective.
  • Management of hypertension should be based on an assessment of cardiovascular risk.

Policy Inertia

  • Many countries have not implemented effective public policies to prevent hypertension and control hypertension (http://www.wcrf.org/policy_public_affairs/nourishing_framework/index.php accessed Feb 2 2014).
  • Some national hypertension organizations do not have policy statements and do not advocate for policies aligned with those developed by the WHO that would effectively prevent and control hypertension.

Clinical Inertia (22)

  • Some national hypertension organizations do not have published strategic plans for diagnosing, treating and controlling hypertension.
  • Many clinicians do not routinely assess blood pressure, and do not initiate or titrate treatment in those with elevated blood pressure readings.

TRANSFORMATION AND REFOCUSSING EFFORTS ON PREVENTION AND CONTROL IS REQUIRED. 

THE WORLD HYPERTENSION LEAGUE RECOMMENDS THE FOLLOWING STEPS BE CONSIDERED.

National Hypertension Organizations:

  • Develop strategic plans for prevention and control of hypertension.
  • Advocate for healthy public policies and especially those that reduce dietary salt/sodium and promote healthy diets and smoking cessation.
  • Ensure there are hypertension management guidelines adapted to the country’s population.
  • Develop strong partnerships with the organizations that represent health care providers that diagnose and manage hypertension.
  • Ensure there is monitoring and evaluation of efforts to prevent and control hypertension.  

Health care professionals:

  • Measure blood pressure at all relevant clinical encounters.
  • Assess cardiovascular risk in those diagnosed with hypertension.
  • Treat those at high cardiovascular risk to controlled blood pressure levels.
  • Assess hypertensive disorders of pregnancy.
  • Advocate for healthy public policy.
  • Encourage and assist community blood pressure screening programs.

Individuals:

  • Eat unprocessed or minimally processed foods most often.
  • Choose low sodium options and do not add salt to food.
  • Be physically active.
  • Attain and maintain a healthy body weight.
  • Avoid exceeding maximum daily and weekly recommended alcohol intake.
  • Get their blood pressure checked regularly and understand what it should be.
  • Advocate for healthy public policies.

Key Messages

  • Hypertension may often be preventable and remains a constant threat to well-being.
  • There are effective policies that could facilitate people making healthy choices which if implemented could largely prevent hypertension from occurring.
  • Hypertension is easy to screen for BUT only about 50% of adults with hypertaension are aware of their condition.
  • Effective lifestyle and drug treatments are available that could control hypertension in most individuals.

 

Acknowledgements: Written by Drs N Campbell, D Lackland and M Niebylski and reviewed by the World Hypertension League and International Hypertension Society Executive.

Reference List 

     (1)   Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380(9859):2224-2260.

     (2)   World Health Organization. A global brief on hypertension: silent killer, global public health crisis. World Health Day 2013. Report, 1-39. 2013. Geneva, Switzerland, World Health Organization

     (3)   Levy D, Larson MG, Vasan RS, Kannel WB, Ho KKL. The Progression From Hypertension to Congestive Heart Failure. JAMA 1996; 275(20):1557-1562.

     (4)   Udani S, Lazich I, Bakris GL. Epidemiology of hypertensive kidney disease. Nat Rev Nephrol 2011; 7(1):11-21.

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     (9)   Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB et al. Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and Men. JAMA 2002; 287(8):1003-1010.

   (10)   Lawes CM, Vander Hoorn S., Rodgers A. Global burden of blood-pressure-related disease, 2001. The Lancet 2008; 371(9623):1513-1518.

   (11)   Gaziano TA, Bitton A, Anand S, Weinstein MC. The global cost of nonoptimal blood pressure. J Hypertens 2009; 27(7):1472-1477.

   (12)   Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S.Population, Institute of Medicine of the National Academies. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Report , v-173. 2010. Washington, DC, USA, National Academies Press.

   (13)   Perkovic V, Huxley R, Wu Y, Prabhakaran D, MacMahon S. The burden of blood pressure-related disease: a neglected priority for global health. Hypertension 2007; 50(6):991-997.

   (14)   Ibrahim MM, Damasceno A. Hypertension in developing countries. Lancet 2012; 380(9841):611-619.

   (15)   World Health Organization. WHO Global status report on noncommunicable diseases 2010. Report, iii-161. 2011. Geneva, Switzerland, WHO Press, World Health Organization.

   (16)   Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the american heart association. Circulation 2012; 126(12):1514-1563.

   (17)   Wilson JF. Can disease prevention save health reform? Ann Intern Med 2009; 151(2):145-148.

   (18)   World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Epert Consultantion. World Health Organization 1, 1-149. 2003. Geneva, Switzerland, World Health Organization.

   (19)   United Nations General Assembly. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases-Draft resolution submitted by the President of the General Assembly. Report, 1-13. 2011. New York, USA, United Nations.

   (20)   National Clinical Guidelines Centre. Hypertension: The clinical management of primary hypertension in adults. National Clinical Guideline Centre 2004; 1:1-310.

   (21)   Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21(11):1983-1992.

   (22)   Kotchen TA. The Search for Strategies to Control Hypertension. Circulation 2010; (122):1141-1143.