Executive summary
High blood pressure is one of the world’s leading risk factors for death and dis-ability. The number of people living with hypertension (blood pressure of ≥140 mmHg systolic or ≥90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.3 billion (1).
This common, deadly condition is an important public health problem that leads to stroke, heart attack, heart failure, kidney damage and many other health problems (2, 3). A study of 87 behavioural, environmental, occupational and metabolic risk factors found that high systolic blood pressure (≥110–115 mmHg) was the single most important risk factor for early death worldwide, leading to an estimated 10.8 million avoidable deaths every year, and a burden of 235 million years of life lost or lived with a disability (disability-adjusted life years, DALYs) annually (3). High blood pressure causes more deaths than other leading risk factors, including tobacco use and high blood sugar.
Hypertension and its associated complications also have enormous economic costs – for patients and their families, health systems and national economies.
People living with the condition incur direct medical costs and lose wages, often in their prime working years, which can be impoverishing for entire families. Hospital and outpatient care for heart attacks and strokes caused by uncontrolled hypertension are expensive for health systems. National econ-omies lose tax income, have decreased productivity, increased health care costs, and increased societal needs for the support of adults surviving heart attack and stroke, and of children whose parents have died or become disa-bled. By one estimate, the economic benefits of improved hypertension treat-ment programmes outweigh the costs by about 18 to one.
Addressing risk factors and managing hypertension
The good news is that hypertension and its associated complications can be addressed. Risk-factor strategies include ensuring that people eat a healthy diet low in sodium, maintain a healthy weight, avoid alcohol and tobacco and take regular physical activity (all of which also contribute to good health more generally). Policies and practices to support these strategies are most effective when implemented across entire populations or within specific settings, such as in schools and at workplaces.
For people who have hypertension, there are ways to minimize its impact on health and wellbeing. The starting point for living well with hypertension and preventing complications is early diagnosis and early, effective treatment – the longer a person lives with undiagnosed and inadequately treated hyperten-sion, the worse their health outcomes are likely to be. Currently, among adults aged 30–79 years with hypertension, only 54% have been diagnosed with the condition, 42% are being treated for their hypertension, and 21% are consid-ered to have their hypertension controlled (4).
In some countries and health care systems, large-scale hypertension control programmes have achieved hypertension control for many patients, giving them longer, healthier lives. The World Health Organization (WHO) HEARTS technical package provides cost-effective strategies that can be implemented at the primary health care level to control blood pressure and prevent heart attack, stroke and other complications. Components of the package include the use of a standardized drug- and dose-specific treatment protocol, uninter-rupted access to quality-assured medications, team-based care, patient-cen-tred services, and a robust monitoring system to track patient progress and health system performance. Follow-up and referral systems are also impor-tant to improve treatment outcomes. Implementation of the HEARTS package and the system improvements this requires in terms of integrated health care services, demonstrates that many of its components support, and can also be applied to, other health problems requiring consistent, long-term care, includ-ing diabetes, chronic kidney disease and HIV/AIDs.
Although hypertension can be prevented and treated, few countries currently do so effectively. Better hypertension management will save lives. Increasing the percentage of people whose hypertension is under control globally to 50% would prevent 76 million deaths between 2023 and 2050. Treating hyper-tension is one of the most important interventions to meet the Sustainable Development Goal (SDG) target 3.4 of a one third reduction in premature mor-tality from the leading noncommunicable diseases.
Conclusions and key messages
Improving the prevention and treatment of hypertension is feasible, low-cost, safe and necessary to achieve global and national targets, including those of the SDGs. Effective hypertension management will bring health, wellbeing, and economic benefits. It will reduce burdens on acute-care services, increase integration of health care systems and, most importantly, reduce the deaths, suffering and costs arising from complications such as heart attack, stroke and kidney failure.Global report on hypertension: the race against a silent killer.