Updated: August 26, 2021 7:22:38 am
Over the past 30 years, the number of adults (aged 30-79 years) living with hypertension worldwide has doubled — rising from an estimated 331 million (33.1 crore) women and 317 (31.7 crore) million men in 1990, to 626 million (62.6 crore) women and 652 million (65.2 crore) men in 2019, with most of this increase occurring in low- and middle-income countries (LMICs). The prevalence of hypertension in India has, however, increased marginally over a period of 30 years, from 28% in women and 29% in men in 1990 to 32% in women and 38% in men in 2019.
The international study, published in The Lancet on Wednesday, analysed blood pressure measurements from more than 100 million (10 crore) people taken over three decades in 184 countries. Hypertension was defined as having systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking medication for high blood pressure.The study was funded by the World Health Organisation and it was conducted by researchers from the Non-Communicable Disease Risk Factor Collaboration.
Despite being straightforward to diagnose and relatively easy to treat with low-cost drugs, nearly half of people (41% of women and 51% of men) with hypertension worldwide in 2019 were unaware of their condition; and more than half of women (53%) and men (62%) with the condition weren’t treated.
Worldwide, blood pressure was controlled (ie, medicines were effective in bringing blood pressure to normal ranges) in fewer than 1 in 4 women and 1 in 5 men with hypertension.
High blood pressure is directly linked to more than 8.5 million (85 lakh) deaths worldwide each year and is the leading risk factor for stroke, ischaemic heart disease, other vascular diseases, and renal disease. Lowering blood pressure can cut the number of strokes by 35%-40%, heart attacks by 20%-25%, and heart failure by around 50% .
Professor Majid Ezzati from Imperial College London, who is the senior author of the study, said, “Our analysis has revealed good practice in diagnosing and treating hypertension not just in high-income countries but also in middle-income countries.”
Prof Avula Laxmaiah, public health epidemiologist at National Institute of Nutrition, Hyderabad, said there was a significant improvement in the diagnosis of treatment, from 12-19% in 1990 to 32-42% among men and women in 2019, respectively. Similarly, treatment and control levels have also significantly improved. However, diagnosis, treatment and control levels are still low when compared to developed countries like Canada, USA, UK and others, Prof Laxmaiah told The Indian Express.
The Centre has been implementing the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) since 2010 up to the district level under the National Health Mission. NPCDCS is focusing on awareness generation for behaviour and lifestyle changes, screening and early diagnosis of persons with high level of risk factors and their referral to appropriate treatment facilities like primary health centres and district hospitals for early diagnosis, treatment, and control of non-communicable diseases including cardiovascular diseases. To accomplish this, there is a need to improve infrastructure facilities and trained health manpower, especially at primary health centre and sub-centre levels, Dr Laxmaiah said.
Meanwhile, according to the Lancet study, many high-income countries, including Canada, Switzerland, the UK and Spain, have reported all-time low prevalence levels, but in low- and middle-income countries, and central European countries such as Paraguay, Hungary, Poland, and Croatia, hypertension rates remain high.
High-income and some middle-income countries have made impressive improvements in treatment and control of hypertension, including Canada, South Korea, Iceland, the USA, Costa Rica, and Germany; but there has been little change in most countries in sub-Saharan Africa and Oceania. Authors have called for best practice in detection, treatment, and control from countries like Costa Rica, Chile, Turkey, Kazakhstan and South Africa to be replicated across low- and middle-income countries.
New WHO guideline for hypertension treatment released
The ‘WHO Guideline for the pharmacological treatment of hypertension in adults’, also released on Wednesday, provides new recommendations to help countries improve management of hypertension. WHO recommends initiation of pharmacological antihypertensive treatment of individuals with a confirmed diagnosis of hypertension and systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg.
Dr 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.”
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