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Global Hypertension Tx Plan

By on May 31, 2014

Recently, the Lancet dedicated an entire issue to hypertension—the biggest contributor to the global burden of disease (GBD) and to global mortality, according to 2010 data from the Institute for Health Metrics and Evaluation.

Hypertension is estimated to contribute to 9·4 million deaths each year worldwide. Ahead of the joint meeting of the European Society of Hypertension and the International Society of Hypertension, to be held in Athens, Greece, June 13—16, three research papers on hypertension will be published.

These three papers illustrate some of the important areas of uncertainty about treatment. Which treatment should be used to maximize outcome and adherence? What is the life time risk of cardiovascular diseases at different levels of blood pressure at different ages and what is the implication for treatment initiation? And has treatment coverage of hypertension improved over time?

Global prevention efforts urgently need to be accelerated. Published online on May 29, the GBD 2013 estimates for overweight and obesity—recognized as important risk factors for hypertension and the reason why even children and adolescents are now hypertensive—are alarming. Worldwide, 36·9% of men and 38% of women are overweight or obese. 
The Centers for Disease Control and Prevention (CDC), together with the Pan American Health Organization, have embarked on an interesting initiative: the Global Standardization of Hypertension Treatment Project, which might provide such a concerted effort. Recognizing that approaches to treatment for tuberculosis and HIV/AIDS could be translated into strategies to combat hypertension—by identifying a core set of cheap and effective medications, standardized treatment protocols, and agreeing key elements of care delivery at national level—the project focuses on hypertension control in the Americas.
The American Society of Hypertension no longer regards hypertension as a single disease entity and recognizes it “as part of a bigger disease conglomerate almost always accompanied by obesity, diabetes, kidney disease or many other co-existing problems involving lifestyle”. Prevention efforts for hypertension need to start by tackling nutrition and diet at an early age at the global level. Salt-reduction strategies are extremely important. But the context for any intervention strategy to prevent or treat hypertension must be adoption of a healthy food environment. We need to hear stronger advocacy for this broader approach from physicians.