Global High Blood Pressure Situation Growing Dire, But Doesn't Have To Be, New Health Report Says

Main Category: Hypertension
Also Included In: Cardiovascular / Cardiology;  Public Health
Article Date: 18 May 2007 - 0:00 PDT

email to a friend   printer friendly   view / write opinions

Instances of uncontrolled hypertension will rise dramatically, triggering a global cardiovascular disease epidemic, unless governments and healthcare policymakers take immediate and wide-ranging corrective action, three international health experts warned today in a report signed on by 14 leading medical groups and voluntary health organizations from around the world.

"During the past 40 years, focused efforts to diagnose and control high blood pressure have helped to achieve significant reductions in cardiovascular disease, stroke incidence and death in the United States," stated Dr. Michael Weber, SUNY Downstate Medical College, New York, one of the authors of the report. "However, we have become complacent. The number of people with high blood pressure is once again on the rise."

The report, High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next, examines the serious medical, economic and human health consequences of high blood pressure, while detailing how to short-circuit a predicted 60% rise over the next 18 years in the number of people suffering from high blood pressure. This means an estimated 1.56 billion people worldwide could be affected by the condition by 2025. Currently, one billion people globally and approximately 72 million Americans have high blood pressure.

Released today in the U.S. at a briefing of healthcare professional and patient advocacy organizations in Washington, D.C., the report authors predict that in the U.S. and other developed nations, the number of adults with high blood pressure will increase from 333 million to 413 million by 2025. The report warns that in developing countries, the number of people with hypertension could rise by 80% to 1.15 billion, meaning that almost three- quarters of people with high blood pressure will be in developing countries by 2025.

U.S. Demands for Public Policy Review

"A concerted public policy effort to prevent cardiovascular disease through more aggressive high blood pressure diagnosis and treatment will save productive lives and dramatically cut healthcare costs," said Representative Donna Christensen (D-Virgin Islands), a physician and member of Congress. "This is an alarming epidemic that needs immediate attention by Congress and this Administration. The current healthcare system cannot support the growing cost burden -- we must review existing high blood pressure programs and identify areas for improved efficiency."

"This report should serve as a wake-up call for all of us. The devastating toll that high blood pressure has had not only on Americans, but people across the world, can be significantly reduced if we focus our attention and efforts," said U.S. Representative Kenny Hulshof (R-MO), a member of the powerful U.S. House of Representatives Ways and Means Subcommittee on Health. "I am committed to working closely with Representative Christensen and other members of the U.S. Congress to ensure that the proper attention and resources are allocated to educating the public and policymakers so we can reverse this trend before it becomes an uncontrollable crisis."

A Global Call to Action

For nations around the world, the report identifies five priorities for collective action by governments, voluntary health organizations, professional societies and healthcare practitioners:

1. Recognize high blood pressure as a global epidemic and a major public health priority.

2. Achieve global consensus-standard goals for managing high blood pressure.

3. Empower family doctors and other front-line healthcare professionals as the first line of global defense against high blood pressure. The report calls for more effective community prevention and asks that primary care nurses and other healthcare professionals receive effective training to play an active role in educating and managing high blood pressure patients.

4. Provide people with high blood pressure education and treatment options that take into account the difficulties in adhering to hypertension regimens.

5. Conduct new, long-term clinical and epidemiological studies to measure the costs and benefits of achieving a more ambitious blood pressure treatment goal and to define risk management strategies that address emerging demographic trends.

A Rise in High Blood Pressure Rates

U.S. government data revealed that high blood pressure is the most common diagnosis in the country. The latest statistics show that 72 million - or one in three adults - have high blood pressure. Prevalence rates are steadily rising, from a rate of 25%, or 50 million adults, between 1988 and 1994 to 29%, or 65 million people, by 2002.

Of special concern are the rising prevalence rates among older women, ethnic minorities, and even teens. The latest data include the following:

-- More American women have high blood pressure than men -- 39 million versus 33 million.

-- The condition is 2-3 times more common in women taking oral contraceptives.

-- African Americans are the most likely to develop high blood pressure and suffer from it earlier and more severely than any other racial or ethnic group. Compared with about 30% of whites, the overall rate among African Americans adults is 41.4% and 44% among African American women. -- High blood pressure is increasing in U.S. children. A study of teens with an average age of 13.5 years showed that 19% had high blood pressure after a first screening.

The Consequences of High Blood Pressure

The higher the individual's blood pressure, the greater the risk of heart attack, stroke, heart failure, kidney disease and eye damage (retinopathy). It is linked with 70% of strokes, affects 60.5% of patients with kidney disease and increases the risk of vascular dementia. Uncontrolled high blood pressure increases the risk of cardiovascular events two- to three-fold. The report predicts significantly higher rates of disability and death in the U.S. and around the world if efforts to prevent and manage hypertension are not improved.

According to the American Heart Association, high blood pressure and its complications are expected to cost the U.S. $66.4 billion in 2007. This figure includes direct costs, such as hospital care and physician services, and lost productivity caused by death and disability from hypertension-related diseases. Moreover, a report by Kathryn Fitch, Kosuke Iwasaki and Bruce Pyenson of Milliman, Inc., examined healthcare costs for U.S. employers and found that employees with high blood pressure averaged $619 in costs compared to $247 for those without the condition on a per member, per month basis for a demographic adjusted population.(1)

"High blood pressure contributes to disabling conditions such as kidney disease, stroke and cardiovascular disease, which increases demand for long- term medical care," said report author Dr. Panos Kanavos, London School of Economics and Political Science. "Increased public spending required to deliver this care is likely to adversely affect governments' fiscal balance, which in turn can have serious implications on overall social spending."

Taking Steps to Reduce High Blood Pressure

The report advocates more systematic health policies and school-based and community-based interventions focusing on lifestyle factors directly linked with high blood pressure: obesity, lack of physical activity, smoking, excessive sodium intake and over-consumption of alcohol. The report also calls to improve the rates of early diagnosis by screening patients for high blood pressure when they visit their physician for other reasons.

The report also recommends assessing and potentially treating patients with pre-hypertension. Pre-hypertension is systolic pressure of 120-139 mmHg or untreated diastolic pressure of 80-89 mmHg. According to the American Heart Association, 37.4% of the U.S. population aged 20 years of age or older has pre-hypertension, including 41.9 million men and 27.8 million women. The rationale for this new classification was the accumulation of data on lifetime risk, which showed that levels of blood pressure previously considered to be normal or high-normal are associated with substantial risks of cardiovascular complications.

"Uncontrolled high blood pressure is a public health dilemma that requires an urgent response on global and national levels," said Dr. Jan Ostergren, Karolinska University Hospital, Stockholm, Sweden, another author of the report. "Public health officials are only now beginning to realize that we need to do a better job of reducing cardiovascular health risks and that controlling high blood pressure is a key strategy."

About the Report

This report is the outcome of a research project conducted at three leading academic centers: London School of Economics in the United Kingdom; Karolinska Institute in Sweden; and State University of New York (SUNY) Downstate Medical College. Two panels of specialists in high blood pressure convened - one in Chicago, the other in Barcelona, Spain - during 2006. In researching issues surrounding hypertension, the experts analyzed existing practice guidelines, position statements of governments and healthcare institutions and health economics. The research was funded through an unrestricted educational grant from Novartis Pharma AG.

The following organizations have reviewed and endorsed the Impact Report's call to action and recommendations: American Society of Hypertension, National Kidney Foundation, Asian Hypertension League, International Diabetes Federation (Europe), International Federation of Kidney Foundations, International Society of Nephrology, World Hypertension League, World Stroke Organization incorporating the World Stroke Federation, International Council of Nurses, the International Stroke Society and Dr. Georgs Andrejevs, MEP. In addition, the following organizations have reviewed and support the report's call to action and recommendations: the European Society of Hypertension and International Society of Hypertension.

The report authors, Michael Weber, MD, SUNY Downstate Medical College, New York, Jan Ostergren, MD, PhD, Karolinska University Hospital, Stockholm, Sweden, and Panos Kanovos, PhD, The London School of Economics, London, UK, are global leaders in healthcare economics and high blood pressure treatment.

References:

(1) Fitch K, Iwasaki K, and Pyenson B. "Uncontrolled Hypertension: Cost to Payers and Employers - An Actuarial Analysis performed by Milliman, Inc."

State University of New York (SUNY) Downstate Medical College
http://www.hscbklyn.edu