High Blood Pressure: A Global Epidemic

Understanding the Global Rise in High Blood Pressure

Several factors have driven the global rise in high blood pressure since the 1970s. The overall growth and ageing of the world’s population means there are simply more people at risk. However, the study indicates lifestyle changes relating to diet and exercise in developing nations are fueling the epidemic. As countries become more prosperous, diets get richer in sugars, refined carbohydrates and unhealthy fats, while physical activity declines. This fuels surges in associated health risks like obesity and diabetes.

Additionally, people in developing countries often have limited access to screening and treatment for high blood pressure. This means many are living with undiagnosed and uncontrolled hypertension, further elevating their risk of heart disease and stroke. Overall, the World Health Organization estimates hypertension contributes to around 9.4 million deaths every year.

The Increasing Burden on Developing Nations

While blood pressure rates have fallen in many high-income countries, developing regions have seen stark increases. The study found the largest rises occurred in South Asia and Sub-Saharan Africa. In South Asian countries like Bangladesh and Nepal, age-standardized high blood pressure rates rose from 17% to 24% in men and 13% to 18% in women between 1975 and 2015. Rates also approximately doubled in Ethiopia and Malawi over the 40-year period.

Researchers said the worst affected areas often faced a “triple whammy” of inadequate medical treatment, poor nutrition, and high salt intake. Addressing these factors with policy initiatives should be an urgent priority. As Professor Majid Ezzati from Imperial College London emphasised, “Profound changes in diet and lifestyle have seen blood pressure rise in low and middle-income countries…We need to mobilise resources for these countries.”

The Importance of Prevention and Control Measures

The NCD-RisC study highlights the critical role government public health policies play in shaping hypertension trends. It found the most impressive reductions in population blood pressure occurred in high-income countries like Canada, the United Kingdom, Australia, and the United States. For example, age-standardized hypertension rates declined from 38% to 24% in Canadian men and 26% to 17% in Canadian women.

These wealthy Western nations have generally had more success promoting healthier diets, implementing salt reduction programs, and improving access to blood pressure screening and medications. The UK in particular has been leading the charge on salt reduction by setting voluntary sodium targets for the food industry. This comprehensive public health approach serves as a model for tackling hypertension globally.

The Gender Gap in Hypertension

Interestingly, the study found that men tend to have higher blood pressure than women across most world regions. There are several potential reasons behind this gender gap:

  • Biological differences may make men intrinsically more susceptible to hypertension. Factors like hormones are thought to be protective for premenopausal women.
  • Lifestyle risks like smoking, heavy alcohol intake, and poor diet quality tend to be higher in men. These contribute to higher cardiovascular disease risk overall.
  • Men can have poorer adherence to medications and tend to visit doctors less frequently. This may result in poorer blood pressure control.

Understanding and addressing the drivers of gender disparities in hypertension control should be part of national public health initiatives.

How Nations Compare on High Blood Pressure in 2015

The study included blood pressure data from 154 countries, providing insights into how the hypertension burden varies regionally:

  • The countries with the lowest blood pressure averages were South Korea and Canada, with 2015 systolic blood pressure around 118mmHg for men and 111mmHg for women.
  • The highest average blood pressures were in Slovenia for men (138mmHg) and Niger for women (133mmHg systolic).
  • Europe demonstrated significant regional variations. The UK, Ireland and Nordic countries like Sweden had some of Europe’s lowest rates. Meanwhile, Central and Eastern European nations including Slovenia, Lithuania and Croatia continued to have highly elevated blood pressure averages.
  • Oceania, North America and Western Europe mostly had lower hypertension rates compared to other regions. However, French Polynesia and Greenland stood out for having high blood pressure averages.
  • Latin American countries spanned the spectrum, with Peru and Ecuador having low averages and Paraguay and Bolivia having high rates.
  • In Africa, blood pressure levels differed starkly between the north and Sub-Saharan regions. Mauritania, Morocco and Ethiopia registered concerning increases.
  • For Asia, South Korea, Singapore and Nepal were among the lowest, while several Central Asian countries like Mongolia and Kazakhstan had very high averages.

These regional comparisons demonstrate the complexity of addressing hypertension but also reinforce that public health policies can lower population blood pressure. While the problem has grown worldwide, declines in Western countries provide a hopeful note.

Promising Progress in Some Developing Nations

While the overall trend is concerning, a few developing countries have managed to reduce high blood pressure rates through concerted efforts:

  • Costa Rica experienced a decline from around 57% to 21% for men and 44% to 11% for women between 1975 and 2015. The country has undertaken nationwide initiatives to reduce dietary salt, increase fruit/vegetable intake and improve access to primary healthcare.
  • Chile also saw reductions over 40 years, which has been attributed to progressive public health policies improving risk factors like obesity. However, its blood pressure levels remain higher than in Costa Rica.
  • Cuba experienced a remarkable decline from 43% to 32% among men and 37% to 22% in women over the period. Its model of universal health coverage and population health focus has likely supported hypertension progress.

These examples demonstrate that with sustained commitment, developing countries can curb hypertension rates even with limited resources.

Improving Hypertension Detection Through Screening

In addition to government prevention policies, increased screening has an important role in tackling high blood pressure globally. In May 2017, 2018 and 2019, the International Society of Hypertension coordinated an awareness and screening initiative called May Measurement Month (MMM). It involved volunteers offering free blood pressure tests around the world during May.

The massive screening drive tested over 4.2 million adults across nearly 100 countries over 3 years. It identified almost 1 million people with previously undiagnosed or inadequately controlled high blood pressure. This highlights the value of community outreach programs in detecting hypertension and connecting people to lifesaving treatment. MMM ceased in 2020 due to COVID-19 but is restarting in May 2021.

Global Solutions to Address the Epidemic

The shifts in hypertension prevalence underscore it is no longer a condition confined to wealthier nations but one requiring urgent action worldwide. As the NCD-RisC study authors emphasized, solutions must focus on supporting poorer nations to implement evidence-based policies.

Strategies should include national dietary changes to reduce salt, sugar and unhealthy fats; improving produce affordability and accessibility; and health system strengthening to detect and control high blood pressure effectively. With diligent application of prevention and treatment approaches, even hard-hit developing countries can hope to reverse rising blood pressure rates.

The epidemic growth of hypertension globally is undoubtedly alarming. Yet successes in bringing down population blood pressure in some Western nations demonstrate it is possible. Implementing policies today to equip developing countries to confront hypertension can help stem a growing health crisis.

Photo by Greg Rosenke on Unsplash

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