Long thought to be a problem only for high income countries, now 80% of deaths connected to high blood pressure (HBP) occur in the developing world. These are the conclusions of authors of an Article in this week's edition of The Lancet.
Cardiovascular disease is now endemic worldwide and no longer limited to economically developed countries. Few studies have assessed the extent and distribution of the blood-pressure burden world wide, so Dr Carlene Lawes, Clinical Trials Research Unit, University of Auckland, New Zealand, and Professor Anthony Rodgers, University of Auckland, New Zealand, and colleagues on behalf of the International Society of Hypertension have addressed this in this study. They estimated the worldwide burden of disease attributable to HBP 115 mm Hg systolic) for groups according to age (30 years), sex, and World Bank region in the year 2001 (the latest year of complete data).
They found that 7.6 million premature deaths (about 13.5% of the global total) and 92 million disability-adjusted life years (DALYs) (6.0% of the global total) were attributed to HBP. About 54% of stroke and 47% of heart disease worldwide were attributed to HBP -- about half this burden was in people with hypertension (140 mm Hg systolic), the remainder was in those with lesser degrees of HBP.
Within high-income countries (including richer European countries, North America, Australia) the proportion of premature deaths due to HBP was higher (17.6%) than within low- and middle-income countries (12.9%), as was the proportion of DALYs due to HBP (9.3% versus 5.6%). However, overall about 80% of the burden occurred in low- and middle-income countries. Eastern Europe, central Asia, east Asia and the Pacific (including China), followed by South Asia (including India) bore the brunt of these HBP-related deaths. More than one-third of all deaths in the lower-income countries of Europe and central Asia region were related to HBP.
In terms of actual numbers of deaths related to HBP, high income countries experienced 418,000 stroke deaths, 668,000 heart disease deaths, 109,000 deaths due to hypertensive disease, and 197,000 due to other cardiovascular diseases -- a total of 1.39 million deaths. These figures were dwarfed by those for HBP-related deaths in low- and middle-income countries: 2.5 million stroke deaths, 2.68 million heart disease deaths, 598,000 hypertensive disease deaths and 445,000 deaths due to other cardiovascular disease -- a total of 6.22 million.
The authors conclude: "Most of the disease burden caused by high blood pressure is borne by low-income and middle-income countries, by people in middle age, and by people with lesser degrees of high blood pressure. Prevention and treatment strategies restricted to rich countries or individuals with hypertension will miss much blood-pressure related disease."
In an accompanying Commentary, Professor Stephen MacMahon, The George Institute for International Health, University of Sydney, NSW, Australia, and colleagues from each of the five continents in the world say: "Middle-income countries and low-income regions have a five times greater burden of disease than high-income regions, with access to less than 10% of the global treatment resource. This travesty cannot continue to be ignored by those most able to bring about change."
Professor Anthony Rodgers, University of Auckland, New Zealand T) +64 21677486 E) a.rodgers@ctru.auckland.ac.nz
For Professor Stephen MacMahon, The George Institute for International Health, University of Sydney, NSW, Australia, please contact Emma Orpilla T) +61 410411983/ +61 299934592 E) smacmahon@george.org.au / eorpilla@george.org.au
http://multimedia.thelancet.com/pdf/press/bloodpressure.pdf
Journal
The Lancet