World blood pressure rises 01:12
Story highlights
- A global study found that 1.13 billion people had high blood pressure in 2015
- The greatest burden is in low- and middle-income countries
(CNN)In
2015, there were 1.13 billion people living with high blood pressure
worldwide, with the majority of them in low and middle-income countries.
The findings come from a new study
published Tuesday in The Lancet, which found that the number of people
affected by high blood pressure has almost doubled over the past 40
years.
In most countries, men were found to have higher blood pressure than women.
The
study highlighted a stark contrast between where people are most
affected, with high-income countries showing a sharp decline in blood
pressure among their populations in recent decades, while low- and
middle-income countries have seen numbers spike -- particularly in South
Asia and Africa.
"When you look at this globally, blood pressure is a condition of poverty, not affluence," said Majit Ezzati, professor of global environmental health at Imperial College London, who led the analysis. "The relationship with national income is completely inverse."
The
difference was made more evident by that fact that half of the world's
adults with high blood pressure in 2015 were living in Asia.
The
United States, Canada and South Korea had the lowest rates in the
world, while the UK had the lowest proportion of people with raised
blood pressure in Europe.
"In the
high-income world ... (rates) are coming down despite the aging and
increasing population," Ezzati said. "But in the population (in Asia),
as the age goes up, the blood pressure tends to be higher."
He
adds that this is most likely down to differences between these
populations in terms of healthy food options but also access to health
services providing diagnosis and treatment.
The global highs and lows
An
estimated 226 million people in China were found to have high blood
pressure, along with 200 million in India. The top five countries for
high blood pressure among men were all in Central and Eastern Europe:
Croatia, Latvia, Lithuania, Hungary and Slovenia. For women, the top
five were all in Africa: Niger, Chad, Mali, Burkina Faso and Somalia.
To
reveal these findings, Ezzati collaborated with the World Health
Organization as well as hundreds of scientists around the world to study
changes in blood pressure in every country between 1975 and 2015.
"We
wanted to know what was happening," said Ezzati, who believes that
blood pressure is a more extensive problem than obesity and diabetes and
warns of the range of health conditions that stem from someone's blood
pressure being raised, such as stroke, heart disease and kidney disease.
Blood pressure is estimated to cause 7.5 million deaths globally, almost 13% of all deaths, according to the WHO.
"As
the leading risk factor for cardiovascular disease, reducing blood
pressure is also a key step to meeting the overarching target of
reducing non-communicable disease mortality," said Gretchen Stevens, a
statistician with the WHO's Department of Information, Evidence and
Research who worked with Ezzati's team.
"This
new study is a first effort at compiling data to assess whether country
trends are progressing in the right direction to meet the World Health
Assembly target," Stevens said, referring to a goal set in 2011 aimed at
reducing the prevalence of high blood pressure by 25% by 2025.
Who is at most risk?
Raised
blood pressure is defined as someone having systolic blood pressure
above 140 and a diastolic blood pressure above 90 -- usually read as
140/90. Systolic pressure is the force with which the heart pumps blood
through the blood vessels, while diastolic pressure measures resistance
in the body's blood vessels to the blood flow.
A
number of factors are known to increase someone's risk of raised blood
pressure, including high levels of salt and potassium in their diet,
environmental factors such as lead exposure and pollution, and lack of
diagnosis and treatment options. Genes also have a role to play.
A
lesser-known risk factor is the role of poor nutrition early in life,
meaning children who are undernourished are more likely to have elevated
blood pressure when they are older.
"All
of these things matter," Ezzati said. Some of these risk factors are
more common in the low-income countries, perhaps explaining why they are
now showing higher burdens of blood pressure, where services to educate
and treat people are also lacking. "They are inevitably part of the
story," he said.
A lack of options
in place to deal with the problem means that number will only continue
to rise in coming years, added Ezzati. "There is no sign of rates
becoming flat," he said. "We should expect worse for a while."
The need for better services
The
team believes that the situation has become as extensive as it is today
due to the failure of the global health community to prioritize the
problem.
Many diseases once thought
to be linked to affluence are now proving to dominate the poorer
regions of the world, including obesity, diabetes and cancer, but Ezzati
believes blood pressure is hitting them the hardest.
"At
the global level, we should be thinking of blood pressure as a
condition of poverty," Ezzati said. He believes strategies need to be
set in place to tackle the problem, such as improving access to fresh
fruits and vegetables throughout the year and channeling aid money to
address better nutrition.
"The
perception is that people are not getting enough calories, but the
reality is, they're not getting healthy calories," said Ezzati. "Making
fresh, healthy food affordable and accessible for everybody should be a
priority."
Targeting obesity and diabetes among poorer nations will involve setting the same priorities.
But
Ezzati also wants health systems to be better prepared to diagnose and
treat raised blood pressure in the poorer regions of the world. "It's
not just prevention," he said.
"These statistics are shocking," said Julie Ward, blood pressure manager at the British Heart Foundation,
adding that 16 million people are living with high blood pressure in
the UK alone. "These findings remind us that people living in deprived
areas are at a much greater risk of having high blood pressure. And we
remain greatly concerned that almost half of all people with high blood
pressure in the UK are unaware of their condition and remain
undiagnosed."
"High blood pressure remains a leading risk factor in many regions globally," Dr. Rajiv Chowdhury, a senior epidemiologist in
the Department of Public Health at the University of Cambridge, wrote
in an email. Chowdhury was not involved in the study but agrees that
environments need to be better tuned to enable people in Asia and Africa
to live healthier lifestyles.
"(The
burden) is driven by suboptimal behavioral factors common in many
African and Asian countries, such as excessive salt consumption, growing
obesity and lack of adherence to antihypertensive medication."
Robert Clarke, professor of public health
at the University of Oxford, added the need for better services
targeting the burden. "The results highlight the need to raise awareness
of hypertension, introduce safe and effective treatment for
hypertension and monitor affected patients to ensure appropriate control
of those who are being treated," he said.
"Hypertension
remains a serious public health problem in the United States, but the
favorable trends observed in the United States and other Western
countries underscores the importance of 'check, change and control'
programs that have been advocated."
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