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A global perspective on hypertension: a Lancet Commission

drpatricioDespite extensive knowledge about how to prevent and treat hypertension, it has been the number one killer in the world for more than 10 years. Elevated blood pressure is the principal risk factor for cardiovascular diseases worldwide,1, 2 affecting one billion individuals globally. It is the cause of 54% of strokes and 47% cases of ischaemic heart disease, and is responsible for 7·6 million premature deaths per year (ie, 13·5% of all deaths worldwide) and 92 million disability-adjusted life-years.

Approximately 80% of all cardiovascular mortality is estimated to occur in low-income and middle-income countries.4 WHO estimates that the prevalence of hypertension is highest in Africa (affecting 46% of adults older than 25 years, as compared with 35% in the Americas and 40% in the rest of the world). Awareness, treatment, and control of hypertension are very low in low-income and middle-income countries, with the PURE study6 reporting that 46·5% of hypertensive participants were aware of their status, but only 32·5% of those treated were controlled. However, awareness, treatment, and control are also relatively low in high-income countries, which is an increasing problem due to longer life expectancy. Moreover, treated people with hypertension, with blood pressure below 140/90 mm Hg, still have an approximately 50% increased risk of any cardiovascular even.

The Lancet has taken the initiative to launch a Commission on hypertension, with the aim of generating a campaign to implement priority actions to improve management of elevated blood pressure and hypertension globally. The Commission will briefly review the current evidence on prevention and treatment of elevated blood pressure and hypertension as well as cardiovascular complications. The focus will be on unsolved issues, with the aim of rethinking these in the context of new techniques for patient characterisation and health education in general. The Commission will also seek to identify new ways to manage hypertension globally. As new techniques will be an important part of the solutions, the suggested actions will not always have a strong evidence base, but will highlight where further research might be most beneficial. Therefore, the aim of the Lancet Commission will not be to do an extensive review on hypertension or to rewrite current guidelines on management of hypertension.

A Lancet Commission on hypertension is timely because the world's population, the global health community in general, and especially policy makers have to be reminded that elevated blood pressure and hypertension still represent the primary preventable cause of cardiovascular disease, despite improved pathophysiological understanding and better antihypertensive drugs. Therefore, management of elevated blood pressure and hypertension has to be improved globally, with different actions depending on regional conditions. In general, identification of people at risk of developing hypertension or its complications, as well as preventive actions, have to be improved. Better characterisation of patients should enable more individualised prevention and treatment, so increasing effectiveness with fewer side-effects leading to better patient compliance. Additionally, better targeted education will improve implementation of current guidelines and empower patients to take responsibility for their own health, improving prevention as well as treatment.

The Commissioners are Sonia Angell, Samira Asma, Pierre Boutouyrie, Dylan Burger, Julio A Chirinos, Albertino Damasceno, Christian Delles, Anne-Paule Gimenez-Roqueplo, Dagmara Hering, Patricio López-Jaramillo, Fernando Martinez, Michael Hecht Olsen (Chair), Vlado Perkovic, Ernest R Rietzschel, Giuseppe Schillaci, Alta Schutte, Angelo Scuteri, James Sharman, Kristian Wachtell, and Ji Guang Wang.

MHO has received research funding from the Novo Nordisk Foundation.

Original content http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961178-3/fulltext