Hypertension is a silent killer: at UNGA80, we must take action

Dr Jagat Narula is President of the World Heart Federation

Hypertension is a ticking time bomb. Between 1990 and 2019, the number of people aged 30-79 years living with the condition doubled from 650 million to 1.28 billion, with more than three-quarters living in low- and middle-income countries.

It is also the most common modifiable risk factor for cardiovascular disease (CVD) and mortality, easily diagnosed and treated through blood pressure screenings and low-cost medication.

And yet, in practice, hypertension is critically neglected in global health discussions. Despite one in three adults being affected, awareness is lacking and health systems’ capacity to detect and treat the issue before it causes other, life-threatening conditions, such as stroke or heart attack, falls drastically short.

On Sept. 25, the United Nations’ High-Level Meeting on Non-Communicable Diseases (NCDs), the first since 2018 and the fourth since 2011, offers a promising opportunity to address the most important health challenge and consequently curb rising rates of cardiovascular disease worldwide. The urgency of this cannot be overstated. Without adequate commitments to improve access to hypertension screenings and treatment, we face a significant, and entirely avoidable, human cost.

A silent killer

Around half of all heart disease and stroke-related deaths globally can be attributed to hypertension, which typically presents without symptoms until it leads to heart attack or a stroke. Because of this, we know four in five people affected are not getting the treatment they need to keep their condition under control.

The impact of this extends far beyond health; the economic consequences of uncontrolled hypertension on patients, families, and health systems are significant. Individuals deal with the strain of medical costs, lost wages, and caregiving burdens on their families; health systems are afflicted with the costs of treating heart attacks and strokes; and economies struggle with diminished productivity, and victims requiring support.

Enabling access to hypertension treatment for just half of those affected could prevent 76 million deaths by 2050 and save $100 billion each year. It is an imperative for governments to ensure people of every age, from children to the elderly, can lead socially productive and fulfilling lives.

Shortfalls in treatment

As the 2030 deadline for achieving the Sustainable Development Goals approaches, progress towards target 3.4 – reducing premature mortality from noncommunicable diseases such as CVD by one-third – remains largely inconsistent and insufficient.

The U.N.’s current target to control hypertension in 150 million more people still leaves over 200 million people at risk from entirely preventable cardiovascular disease, the majority of whom also live in low- or middle-income countries with limited support.

Bolder action is needed to ensure equitable access to treatment for all populations. In fact, if governments were to commit to expanding hypertension treatment to 500 million more people by 2030, the target of achieving 50% hypertension control in the next five years would finally be within reach.

Crucially, such a commitment alone is not enough.

It must be reinforced by other concrete actions that tackle the root causes of hypertension and its complications: from implementing fiscal policies that reduce the consumption of products like alcohol and sugar-sweetened beverages; to implementing the World Health Organization’s 2021 Global Air Quality guidelines to prevent over 4.5 million CVD-related deaths attributable to air pollution; and addressing the inequities that hamper cardiovascular disease management globally, such as shrinking health budgets and development assistance for low- and middle-income countries.

Turning point

This year could be a watershed moment for global hypertension control and prevention, and much-needed progress on cardiovascular health. The upcoming U.N. High-Level Meeting still has the potential to mobilise countries to align their national health policies and budgets to match/meet the scale of the global health crisis we face right now.

We should not let this moment pass without driving major change on hypertension control, which could mean the difference between a healthier future, and an avoidable catastrophe.