The global challenge of hypertension

High systolic blood pressure is the top risk factor for attributable deaths and, in 2019, hypertension accounted for about a fifth of all deaths (around 11 million) globally. This highly preventable and treatable condition is the leading risk factor for ischaemic stroke and intracerebral haemorrhage and is implicated in other non-communicable diseases (NCDs), including cerebral small vessel disease and dementia. Despite widespread knowledge about how to diagnose and define hypertension, and the availability of effective and cheap antihypertensive drugs, the number of adults with high blood pressure has doubled since 1990, to about 1·3 billion in 2019. Concerningly, only half of people with hypertension know they have it, and the condition is only controlled in a fifth; in countries of low and middle income (LMICs), these figures are starker, with hypertension control achieved for less than 5% of people with high blood pressure in most African countries. In response to this alarming situation, WHO published (on Sept 16, 2023) their first report on hypertension. The Global report on hypertension: the race against a silent killer serves as a reminder that hypertension is both a global health issue and a public health challenge, and it makes feasible recommendations for action that countries should take. The WHO report describes the burden of hypertension from a global health perspective—eg, by highlighting how control of hypertension will contribute to target 3.4 of the UN Sustainable Development Goals, to reduce by a third premature deaths from NCDs by 2030. The WHO report also focuses on the public health challenges of hypertension for individual countries. For example, despite the availability of cheap and effective blood pressure medications, the financial costs of uncontrolled hypertension can still be substantial to individuals, their families, and national health systems. The WHO report notes that out-of-pocket expenses can be accrued by people who attend health clinics or need medicine to control blood pressure; if hypertension leads to a stroke or heart attack, an inability to work can lead to lost earnings. Stroke care in hospital, or later at an outpatient clinic, can increase costs to governments for health and social care. The WHO report also includes statistics for every WHO Member State on prevalence, mortality, risk factors, uncontrolled hypertension, and national response (eg, whether targets have been set for salt intake and blood pressure, and if a surveillance programme is ongoing). These country profiles provide a baseline for the national burden of hypertension and are intended to support future monitoring programmes. The recommendations for addressing hypertension that are outlined in the WHO report will require cooperation and action from multiple stakeholders at a local, national, and global level. One practical suggestion is to implement education programmes in schools or workplaces about factors that can increase the risk of hypertension, with advice to avoid alcohol and tobacco, eat a healthy diet and reduce sodium intake, and increase physical activity. This recommendation offers a starting point that could also have wide-ranging benefits for health outside the management of hypertension. Another recommendation is for countries to introduce a strategy for early diagnosis and treatment of hypertension—a crucial step for improving outcomes for people with high blood pressure. However, some LMICs currently do not have the means to provide and train the staff required to introduce such a strategy, or a health-care system with the infrastructure to implement it, and so this recommendation will require political commitment and financial investment. A key recommendation of the WHO report is for countries to implement the HEARTS technical package. HEARTS is a cost-effective strategy to tackle hypertension, comprising a standard treatment protocol, uninterrupted access to essential medicines, patient-centred and team-based care, and robust monitoring, and it has already been implemented successfully in several LMICs. The recommendations in the WHO report on hypertension align closely with those in the World Stroke Organization (WSO)–Lancet Neurology Commission, which presents “pragmatic solutions to reduce the global burden of stroke”, among which strategies to improve the prevention and treatment of hypertension are crucial. New data in the WSO–Lancet Neurology Commission forecast a large increase in the burden of stroke from 2020 to 2050, from about 145 million disability-adjusted life years (DALYs) to 189 million DALYs. Hypertension control is, thus, of large concern. Implementation of the WHO recommendations should become a local, national, and global priority, to save lives. Treatment for Alzheimer's disease: time to get readyAdvances in Alzheimer's disease research over the past two decades have led to innovations in biomarkers and diagnostic criteria, and have paved the way for the first disease-modifying trials with positive results. Drugs able to remove amyloid plaques from the brain are now starting to become available; efforts to slow cognitive decline are turning a corner. The translation of these breakthroughs into neurology clinics has begun and will have major implications for health-care systems, especially in regions where populations are ageing rapidly. Full-Text PDF Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology CommissionStroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. Full-Text PDF Prevention of dementia with holistic brain healthYour Editorial of June, 2023, declares that it is “time to get ready” for treatment of Alzheimer's disease,1 but it is also “time to get ready” for prevention. The world is facing a growing crisis as the ageing population trends upwards, bearing a burden of dementia, while the birth rate trends downwards, resulting in fewer working-age people. Japan offers the most extreme example of these trends: life expectancy is now 85 years old, and the birth rate has declined to 1·3 births per woman, from 2·1 births per woman. Full-Text PDF