Raising the pressure on hypertension
Autor: Renzo Signaling | Publicado: 2013-04-05T09:54:00-07:00


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60780-1/fulltext?elsca1=ETOC-LANCET&amp;elsca2=email&amp;elsca3=E24A35F

The Lancet, Volume 381, Issue 9873, Page 1157, 6 April 2013
doi:10.1016/S0140-6736(13)60780-1Cite or Link Using DOIRaising the pressure on hypertensionThe LancetCardiovascular disease is not exclusive to the modern era. In The Lancet today, Randall C Thompson and colleagues show in the HORUS study—the largest set of mummies to date—that atherosclerosis was common in ancient people of varying lifestyle, geographical location, and over different time periods. Probable or definite atherosclerosis was noted in 47 (37%) of the 137 mummies imaged by whole body CT scan. Ultra-processed foods had not touched their ancient lips—and by contrast with earlier work, the study included individuals from hunter-gatherer communities. Although the findings should not detract from important efforts towards a healthy diet and lifestyle, the study highlights that there is still more to understand about cardiovascular disease risk.One of the most important risk factors for cardiovascular disease is hypertension. To mark World Health Day (WHD) on April 7, WHO has released a new report: A Global Brief on Hypertension. High blood pressure is defined as systolic blood pressure equal to or above 140 mm Hg and diastolic pressure above 90 mm Hg. The Global Burden of Diseases Study 2010 (GBD 2010) reported that high blood pressure is the leading risk factor for global disease burden, and is estimated to cause 9·4 million deaths every year—more than half of the estimated 17 million deaths a year caused by total cardiovascular disease. In 2012, the World Health Assembly set a global goal of a 25% reduction of premature deaths from non-communicable diseases (NCDs) by 2025 (the 25 by 25 goal). Among the set of voluntary targets is a 25% relative reduction in the prevalence of raised blood pressure. The new WHO report outlines crucial components for any country initiative to address hypertension, which include integrated primary care programmes, the provision of basic diagnosis and medicines, and the reduction of risk factors in the population—such as dietary salt consumption, smoking, and physical inactivity.To succeed in reducing hypertension worldwide, efforts should be targeted where they are most needed. The LancetSeries on NCDs reported that hypertension and other compounding risk factors for NCDs, such as tobacco and obesity, are increasingly concentrated in low-income and middle-income countries. 80% of deaths due to cardiovascular disease occur in countries and poor communities where health systems are weak. The African region has the highest prevalence of hypertension among adults older than 25 years. In China, more than 50% of the disease burden is expected to be from cardiovascular disease by 2050. Prompt management of high blood pressure can reduce the risk of complications—such as the development of atherosclerotic plaques, ischaemic heart disease, stroke, renal disease, and retinopathy. However, in the early stages, high blood pressure does not usually cause noticeable symptoms, and patients are left undiagnosed, or might not have access to treatment. Treatment of the complications of hypertension, such as cardiac bypass surgery and renal dialysis, are expensive, and can rapidly deplete family and national budgets. Cardiovascular disease, including hypertension, now accounts for nearly half of the estimated US$500 billion annual lost economic output associated with NCDs in low-income and middle-income countries.Strong leadership and a multi-sectorial approach are crucial to successfully address these challenges. One promising new leadership entity was welcomed earlier this week into the NCD fray. Public Health England (PHE), a new executive agency of the UK Department of Health, is described in a World Report this week. Duncan Selbie, the new Chief Executive, is also profiled in this issue. One of PHE's key priorities is to reduce preventable deaths from disorders such as heart disease, stroke, cancer, and diabetes. Although there is hope that the new system will more effectively address the social determinants of health by combining multi-sectorial functions in one agency, it remains to be seen how successful PHE will be in supporting and inspiring local government.Modification of behavioural risk factors and medical treatment of people at high risk for cardiovascular disease continue to be the best way forward—both to reduce the burden of high blood pressure, and to make progress towards the 25 by 25 goal. But WHD 2013 must be more than a fleeting moment for hypertension. In the context of the dismal progress on the post-2015 development agenda—where health is not yet mentioned—WHD 2013 should be the catalyst for a committed scale-up of resources directed towards addressing the world's most important risk factor for preventable mortality. Only then will NCDs have a reasonable chance of being relegated to ancient history.