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Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Schutte AE 1 , Jafar TH 2 , Poulter NR 3 , Damasceno A 4 , Khan NA 5 , Nilsson PM 6 Show all authors , Alsaid J 7 , Neupane D 8 , Kario K 9 , Beheiry H 10 , Brouwers S 11 , Burger D 12 , Charchar FJ 13 , Cho MC 14 , Guzik TJ 15 , Haji Al-Saedi GF 16 , Ishaq M 17 , Itoh H 18 , Jones ESW 19 , Khan T 20 , Kokubo Y 21 , Kotruchin P 22 , Muxfeldt E 23 , Odili A 24 , Patil M 25 , Ralapanawa U 26 , Romero CA 27 , Schlaich MP 28 , Shehab A 29 , Mooi CS 30 , Steckelings UM 31 , Stergiou G 32 , Touyz RM 33 , Unger T 34 , Wainford RD 35 , Wang JG 36 , Williams B 37 , Wynne BM 38 , Tomaszewski M 39

Affiliations 

  • 1 School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
  • 2 Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
  • 3 Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
  • 4 Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
  • 5 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • 6 Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
  • 7 Ochsner Health System, New Orleans, Louisiana, USA
  • 8 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  • 9 Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
  • 10 International University of Africa, Khartoum, Sudan
  • 11 Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
  • 12 Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 13 Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
  • 14 Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
  • 15 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  • 16 Baghdad College of Medicine, Baghdad, Iraq
  • 17 Pakistan Hypertension League, Karachi, Pakistan
  • 18 Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
  • 19 Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
  • 20 Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
  • 21 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
  • 22 Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 23 University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
  • 24 Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
  • 25 Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
  • 26 Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
  • 27 Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
  • 28 Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
  • 29 College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
  • 30 Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
  • 31 Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
  • 32 Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
  • 33 Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
  • 34 CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
  • 35 Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
  • 36 Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 37 Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
  • 38 Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
  • 39 Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
Cardiovasc Res, 2023 Mar 31;119(2):381-409.
PMID: 36219457 DOI: 10.1093/cvr/cvac130

Abstract

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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