Living with hypertension is often unnoticeable and has few symptoms. However, symptoms of extreme high blood pressure, such as severe headaches, could be life threatening. If untreated, hypertension increases your risk of serious problems such as heart attacks and strokes. According to NHS statistics, around a third of adults in the UK have high blood pressure, although many will not realise it.
In a joint study, with Imperial College London, WHO revealed that the number of adults aged 30-79 years with hypertension has increased from 650 million to 1.28 billion in the last thirty years, and that nearly half of these people did not know they had hypertension.
Hypertension significantly increases the risk of heart, brain and kidney diseases, and is one of the top causes of death and disease throughout the world.
It can be easily detected through 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 over 100 million people aged 30–79 years in 184 countries, together covering 99 percent of the global population, making it the most comprehensive review of global trends in hypertension to date.
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By analysing this immense amount of data, researchers found that there was little change in the overall rate of hypertension in the world from 1990 to 2019, but the burden has shifted from wealthy nations to low- and middle-income countries. The rate of hypertension has decreased in wealthy countries but has increased in many low or middle-income countries.
The UK came eighth in the rankings of countries with the largest decline in hypertension prevalence between 1990 and 2019 for women and third for men.
However, the UK did not make it in the top 10 countries with the highest treatment rate in 2019.
As a result, 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.
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Considerable gaps in diagnosis and treatment
Although it is straightforward to diagnose hypertension and relatively easy to treat the condition with low-cost drugs, the study revealed about 580 million people with hypertension were completely unaware of their condition because they were never diagnosed.
The study also discovered that more than half of people with hypertension, or a total 720 million people, were not receiving the treatment that they need. Blood pressure was controlled in fewer than one in four women and one in five men with hypertension.
Professor Majid Ezzati, senior author of the study said: “Nearly half a century after we started treating hypertension, which is easy to diagnose and treat with low-cost medicines, it is 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.”
The Professor of Global Environmental Health at the School of Public Health at Imperial College London also explained that men and women in Canada, Iceland and the Republic of Korea were most likely to receive medication the fastest with more than 70 percent of those with hypertension receiving treatment in 2019. Compared to below 20 percent of people in sub-Saharan Africa and south-east Asia.
Due to the concerns raised by the release of the study, new WHO guidance has been brought into place to help increase the global rates of treatment for hypertension.
The ‘WHO Guideline for the pharmacological treatment of hypertension in adults’ provides new recommendations to help countries improve the management of hypertension.
Doctor Taskeen Khan, of WHO’s Department of Noncommunicable Diseases, who led the guideline development, said: “The new global guideline on the treatment of hypertension, the first in 20 years, provides the most current and relevant evidence-based guidance on the initiation of medicines for hypertension in adults.”
The recommendations cover the level of blood pressure to start medication, what type of medicine or combination of medicines to use, the target blood pressure level, and how often to have follow-up checks on blood pressure.
Furthermore, the guideline provides the basis for how physicians and other health workers can contribute to improving hypertension detection and management.
Doctor Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases added: “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.”
The authors of the study have called for higher-income countries to do more to help the backlog of treatment in those countries with poorer healthcare technology – where patents continue to suffer.