A call for intensified efforts to prevent and control hypertension is the theme of World Health Day 2013, observed earlier this month by the World Health Organization (WHO) to focus attention on reducing heart attacks and strokes.
The WHO selects a priority area of global public health concern as a new World Health Day theme every year. This year’s hypertension campaign has the following specific objectives:
• Raise awareness of the causes and consequences of high blood pressure.
• Provide information on how to prevent high blood pressure and related complications.
• Encourage adults to check their blood pressure and to follow the advice of health care professionals.
• Encourage self-care to prevent high blood pressure.
• Make blood pressure measurement affordable to everyone.
• Encourage national and local authorities to create enabling environments for healthy behaviors.
Detection and control of high blood pressure must be coupled with simultaneous reduction of other risk factors that cause heart attacks and strokes, such as diabetes mellitus (DM) and tobacco use, the WHO noted. They should be core elements of primary health care in all countries and integral to efforts to reduce the growing burden of noncommunicable diseases.
Why hypertension is a global public health issue is discussed in depth in “A Global Brief on Hypertension: Silent Killer, Global Public Health Crisis,” which the WHO published on World Health Day 2013. The document describes how hypertension contributes to the burden of heart disease, stroke, and kidney failure and premature death and disability. It explains how hypertension is both preventable and treatable and how all concerned parties can join forces to reduce hypertension and its impact.
The WHO’s global brief outlines many behavioral risk factors for the development of hypertension. They include the following:
• Consumption of food that contains too much salt and fat and insufficient consumption of fruit and vegetables.
• Harmful levels of alcohol use.
• Physical inactivity and lack of exercise.
• Poor stress management.
Integrated programs for the control of hypertension must be established at the primary care level, the document suggested, noting that in most countries this is the weakest level of the health system. Treatment should be targeted at persons who are at medium or high risk for heart attack, stroke, or kidney damage; patients who present with hypertension should have a cardiovascular risk assessment, including tests for DM and other risk factors, it was suggested.
WHO tools such as the WHO/International Society of Hypertension (ISH) risk prediction charts are designed to aid risk assessment. WHO/ISH charts are available for all WHO subregions.
Evidence-based guidance is also available on managing patients with hypertension through integrated programs even in resource-constrained settings. WHO tools also provide evidence-based guidance on the appropriate use of medicines, so that unnecessary costs related to drug therapy can be avoided to ensure sustainability of programs.
The WHO document has set the following voluntary global targets to be achieved by 2025:
• A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, DM, or chronic respiratory diseases.
• At least a 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.
• A 10% relative reduction in the prevalence of insufficient physical activity.
• A 30% relative reduction in mean population intake of salt/sodium intake.
• A 30% relative reduction in the prevalence of current tobacco use in persons older than 15 years.
• A 25% relative reduction in the prevalence of raised blood pressure or containment of the prevalence of raised blood pressure according to national circumstances.
• A halt in the rise in DM and obesity.
• At least 50% of eligible persons receiving drug therapy and counseling (including blood sugar control) to prevent heart attacks and strokes.
• An 80% availability of the affordable basic technologies and essential medicines, including generic drugs, required to treat major noncommunicable diseases in both public and private facilities.