Hypertension: Burden, epidemiology and priority interventions

Abstract

Hypertension, which is generally asymptomatic, is the leading cause of death worldwide, largely through cardiovascular disease (particularly ischaemic heart disease and stroke). The relation between blood pressure (BP) and adverse outcomes is seen even with levels of BP below 120/80 mmHg. Primary prevention aims at reducing risk factors of high BP in the entire population, e.g. overweight, high salt intake and a diet low in vegetables and fruit. At the individual level, behavioural counselling is useful. BP-lowering treatment is often required and is cost-effective and inexpensive but is required for many years or indeed for life. Given the high prevalence of hypertension (often >30-40% after the age of 40), effective treatment requires strong health care services, including at the primary health care level, where most hypertensive patients can be handled. A number of factors related to prevention, treatment and health system strengthening are described, including task sharing, single-pill combinations and other measures that can enhance adherence to treatment in the long term. As for all persons at increased CVD risk, a total risk approach is warranted for an optimal use of the available resources.