The Most Overlooked Risk Factor for Death: Hypertension

It’s highly likely that you know someone, possibly even yourself, who is living with hypertension, also known as high blood pressure.

The World Health Organization (WHO) has released its first global report on hypertension, revealing that one out of every three adults suffers from this condition. In the past three decades, the number of people affected by hypertension has doubled, reaching a staggering 1.3 billion.

Despite its prevalence, hypertension is often taken for granted or seen as a relatively harmless ailment. However, it is actually the primary risk factor for mortality, frequently associated with heart attacks and strokes.

The good news is that treating hypertension doesn’t require complex measures or significant financial resources.

“Treatment is easy, affordable, safe, and can be provided by nurses, pharmacists, and community health workers,” emphasized Tom Frieden, the head of Resolve to Save Lives, a health nonprofit, during a recent press briefing.

One effective method is through dietary changes. Lowering sodium intake and increasing potassium consumption has been proven to lower blood pressure. This means reducing the consumption of highly processed foods and incorporating more fiber, fruits, and vegetables into one’s diet. The use of salt substitutes enriched with potassium has also shown positive results (though the WHO does not provide recommendations on potassium supplements).

“Excessive sodium consumption is a major risk factor and contributes to more deaths than any other dietary factor. However, only 6% of countries worldwide have effective measures in place to address this issue,” explained Frieden.

Frieden also noted that policies have been implemented to curb sodium consumption, such as setting salt targets for packaged foods, adopting healthy public food procurement and service policies, and implementing front-of-pack warnings, as done in South American countries.

However, as outlined in the WHO report, relying solely on dietary habits and increased physical activity has its limitations when managing hypertension. Medication is often necessary for individuals diagnosed with the condition. While lifestyle changes can complement drug therapy, they cannot replace it.

Unfortunately, access to medication is not always guaranteed. One of the reasons for this is the highly inconsistent pricing of hypertension drugs, despite the fact that safe and effective medications can be manufactured at low cost. In some cases, the markup on amlodipine in Kenya can exceed 340%.

“There is a significant access problem,” observed Bente Mikkelsen, the director of noncommunicable diseases for the WHO, during the press briefing. “The prices of medicines are almost catastrophic, considering that these are very inexpensive molecules.”

The lack of medication availability contributes to disparities in treatment. Frieden stated, “Treatment for high blood pressure has been the standard of care in higher-income countries for over 50 years. It’s time for it to become the standard of care for everyone worldwide.”

He further emphasized that ensuring a regular supply of medications and affordable blood pressure monitors could cost as little as $5 per patient per year. Yet, many countries have struggled to allocate sufficient funding, resulting in considerable variability in medication costs across nations.

“This presents excellent value for money,” Mikkelsen concurred. “It is immoral that we have off-patent medicines that are not readily accessible.”

Frieden added, “Unless medication is provided free of charge, the poorest and most vulnerable patients may have to make the difficult choice between buying food or buying medicine.”

One country that has successfully transformed hypertension treatment is Bangladesh, where free care has significantly increased the number of patients receiving treatment while also improving control rates.

Aside from reducing sodium intake, addressing air pollution and lead exposure, other crucial factors in this success include free and accessible clinic visits and medications. Frieden described, “We are witnessing encouraging progress with treatment programs in Bangladesh, the Philippines, and India. It shows that with strong government leadership, ownership, and effective programs, combating hypertension at scale is possible.”

Governments need to allocate more resources towards diagnosing and treating hypertension, including implementing the basic practice of assessing blood pressure in primary healthcare clinics. Mikkelsen emphasized, “There is no excuse for any country to not measure blood pressure.”

However, the global development community also has a vital role to play. The traditional focus on infectious diseases has resulted in neglecting noncommunicable diseases such as hypertension.

“In some countries, primary healthcare facilities have been primarily established for conditions like HIV or malaria,” noted Mikkelsen. Integrating basic practices like blood pressure monitoring into these facilities without compromising existing work would aid in reducing mortality rates.

Frieden labeled it “unacceptable” that less than 1% of global health development funding is directed towards addressing the leading cause of death worldwide.

Frieden concluded, “Improved blood pressure control has the potential to prevent more than 70 million deaths, as well as approximately 120 million strokes and 80 million heart attacks in the next 25 years.” However, achieving this requires the commitment and funding to make a difference.

Ultimately, Frieden declared, “This is a pivotal moment. It’s a turning point.”