In a World Heart Federation roadmap editorial focused on reducing the burden of noncommunicable disease, Alma J. Adler, PhD, a science officer at the World Heart Federation in Geneva, and colleagues discussed the ways in which elevated BP contributes to premature mortality.
Hypertension represents a major challenge for a global effort initiated by the World Heart Federation (WHF) to achieve a 25% reduction in the number of preventable deaths by 2025, the authors wrote.
The Raised Blood Pressure Roadmap is primarily focused on hypertension because randomized controlled trials have exhibited measurable decreases in CVD when treating patients at the hypertensive level, according to Adler and colleagues.
“We estimate that the greatest impact on the prevention of CVD events can be made among those in the hypertensive range in the short time that is available to achieve the [noncommunicable disease] targets up to 2025,” they wrote. “However, this high risk-orientated approach does not deny the critical importance of primordial prevention.”
To this end, the authors advocated increased awareness of modifiable risk factors, including unhealthy diets high in salt or low in fruits and vegetables, excessive alcohol consumption, lack of physical activity and overweight/obesity.
After evaluating the potential barriers to effective global hypertension prevention, control and treatment, the authors identified potentially cost-effective strategies for surmounting these obstacles. The roadmap elucidated the “ideal journey” for patients with hypertension, which includes the following:
- willingness of both government and society to prioritize hypertension control;
- promoting patient awareness of their own BP;
- advocating lifestyle changes for the prevention and treatment of hypertension;
- cost-effective treatment and medications; and
- patient/provider education about hypertension treatment compliance and the importance of a lifelong commitment to BP control.
The authors noted that specific obstacles and solutions tend to vary by location, and they underscored the need to adapt strategies according to these differences. They outlined some of the most important solutions, specifically those essential to low- and middle-income countries:
- opportunistic screening;
- development of clear and realistic guidelines, and educating providers about these guidelines;
- introduction of task-sharing and increasing the scope of practice;
- development and maximizing of clinical decision support systems for health care providers;
- establishing and maintaining strong relationships with to hypertension societies;
- promotion of affordable, high-quality generic drugs;
- bolstering of e-health initiatives and education for patients and caregivers;
- developing education programs for patients and caregivers about the importance of treatment compliance and long-term treatment; and
- supporting technologies and information systems aimed at improving treatment adherence.
According to the authors, the Roadmap is aimed at maximizing global BP control in the most cost-effective manner.
“There are proven cost-effective lifestyle and medical interventions to prevent and manage hypertension,” they wrote. “However, uptake is still unacceptably low, particularly in resource-poor areas. … The improved management of hypertension is crucial to the overall goal of reducing premature mortality by 25% in 2025.” – by Jennifer Byrne
Disclosure: Adler reports no relevant financial disclosures. Please see the paper for a full list of other authors’ relevant financial disclosures.