The importance of addressing hypertension

According to Frieden, hypertension kills more than 10 million people a year worldwide, and over a third of those deaths occur in adults younger than 70 years old.

Improving hypertension care "can save millions of lives each year — more than any other adult health-care intervention," Frieden writes.

Frieden adds that a global goal is to treat half of all patients with hypertension effectively, reducing their blood pressure to 140/90 or less. Globally, almost a fifth of those with hypertension receive effective treatment, Frieden writes. In the United States, that number is less than half. In fact, just four countries — Canada, Costa Rica, Iceland, and South Korea — provide effective hypertension treatment to half of those who need it, Frieden writes.

Two million deaths each year and 200 million strokes and heart attacks over the next 25 years could be prevented if global hypertension control was improved to 50% of all who have the condition, Frieden writes. Improving care would also save billions of dollars in avoided hospitalizations, disability, and lost productivity.

How to effectively address hypertension

According to Frieden, more money needs to be allocated to addressing hypertension. Currently, less than one half of 1% of global health funds go toward combating hypertension.

Increasing funding can make a difference, Frieden writes. Prevention and treatment programs for HIV led by the President's Emergency Plan for AIDS relief have prevented 25 million deaths, and childhood vaccines prevent millions of deaths every year.

Most funding would need to be provided by national governments, Frieden writes. Medications for hypertension can cost less than $5 per year, but to achieve the lifelong adherence needed to effectively address hypertension, countries will need to provide medications conveniently and for free. Countries also need to improve primary healthcare, Frieden writes.

The World Bank could loan funds to improve primary healthcare focusing specifically on outcomes, including hypertension control, Frieden writes. Meanwhile, the Global Fund to Fight AIDS, Tuberculosis, and Malaria could facilitate the acquisition of low-cost, high-quality blood pressure medications and monitors.

Other effective treatment programs include utilizing a step-by-step guide for prescriptions, ensuring drug supply, and making services free and convenient, Frieden writes. Programs would also track blood pressure control rates each month and provide healthcare workers with simple digital systems that could improve patient care and control rates.

Prevention of hypertension also includes reducing sodium and increasing potassium intake through potassium-enriched low-sodium salts, Frieden writes. Since low-sodium salt is more expensive than standard table salt, it may require regulatory measures as well as promotion and subsidies to ensure widespread adoption. Frieden also notes that FDA should set, monitor, and enforce targets to reduce sodium levels in packaged foods.

While breakthrough drugs like the weight-loss treatment Wegovy "are exciting," Frieden writes, "the biggest health breakthrough of 2024 would be getting 100 million more people treated effectively for hypertension, the world's leading killer." (Frieden, Washington Post, 2/7)

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