Global hypertension treatment will save millions of lives

Standardized approaches necessary to expand treatment access worldwide

In just 10 years, 10 million heart attacks and strokes could be averted worldwide by treating just half the people with uncontrolled hypertension, commonly known as high blood pressure, suggests CDC Director Tom Frieden, M.D., M.P.H., and colleagues in a Lancet commentary published today.

Most people with uncontrolled hypertension live in low- and middle-income countries (LMICs) and have limited access to diagnosis, care, and treatment. But getting them into treatment and saving millions of lives is not a dream. The Global Standardized Hypertension Treatment (GSHT) Project, being rolled out by CDC in collaboration with the Pan American Health Organization (PAHO), provides a promising approach for countries of all income levels.

“Heart disease and stroke are silent killers – on a mass scale. Cardiovascular disease kills more people around the world than all infectious diseases combined,” said CDC Director Tom Frieden, M.D., M.P.H.  “Hypertension is a major contributor to cardiovascular disease and the question is not whether treatment of hypertension should be undertaken on a global scale, but how quickly effective programs can be established.”

“Hypertension affects some 250 million people in the Americas, and in most countries rates of blood pressure control are unacceptably low,” said PAHO Director Carissa Etienne, M.D., M.Sc. “Scaling-up the GSHT Project holds tremendous potential for reducing premature mortality and the adverse economic impact of cardiovascular disease in this region and around the world.”

Add up all the deaths from all the infectious diseases in the world each year and the total would just about equal the annual toll from high blood pressure: 9.4 million deaths worldwide. That is because hypertension is a leading cause of cardiovascular disease – heart attack and stroke – the world’s biggest killer.

The irony is that while high blood pressure – hypertension – probably is the easiest chronic non-communicable disease to treat, only 13 percent of the 1 billion people with the disorder worldwide have it under control. The good news is that effective treatment is available. The even better news is that hypertension treatments can be made relatively inexpensive – even for people in LMICs, and even though most patients will need two different medications for optimal control. 

Drawing on the successful, mass scale-up of HIV and tuberculosis treatment in LMICs, the GSHT Project is based on four principles:

• First, agree on standardized treatment approaches, including specifics on follow-up intervals, drugs, and dosages to be used.
• Second, recognize that every member of the health care team — primary care workers, community volunteers, pharmacists, nurses, and others — is critical to controlling blood pressure.
• Third, reduce barriers for patients. Eliminate cost barriers to treatment with effective, low-cost medicines. Give only once-a-day medications; combine medications when possible into a single two-drug pill. Simplify medication refill. Reduce salt and sodium intake.
• Fourth, ensure accountability. Track the progress and blood-pressure of every patient diagnosed.

The PAHO Strategic Fund, created by PAHO in 2000 to assist member states in procuring essential medicines and basic public health products, has supported the GSHT Project by helping to ensure lower hypertension drug prices for even the smallest member states. Every nation in the Americas can now buy five of the six recommended hypertension drugs through the Fund’s strategic purchasing agreements.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES