By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
The WHO South-East Asia Region is accelerating action to prevent, detect and control hypertension, which affects an estimated 1.28 billion people globally, two thirds of them in low- and middle-income countries. An estimated 46% of people with hypertension globally are unaware that they have the condition, and less than half of all adults with hypertension are diagnosed and treated. Just 1 in 5 adults with hypertension have it under control, meaning 80% are at significant risk of complications, including heart attack, stroke, irregular heart-beat and kidney damage. In 2015 a quarter of all adults in the Region had hypertension, and in most parts of the Region, less than 50% of people with hypertension are on treatment, indicating an urgent need to scale up hypertension services, especially at the primary health care (PHC) level. The theme of this year’s World Hypertension Day – “Measure your blood pressure, control it, live longer” – highlights the need to increase awareness and access for all people in the Region to quality hypertension services.
The Region has in recent years made targeted efforts to address hypertension and other cardiovascular diseases, in line with its Flagship Priority on preventing and controlling noncommunicable diseases (NCDs) through high-impact and cost-effective “best buys”. Nine countries of the Region have made targeted interventions to improve care pathways at the primary level, as per the WHO Package of Essential NCD Interventions for PHC. Sri Lanka, Nepal and Bhutan have in recent years piloted innovative PHC-focused care models in several districts and areas, while India has significantly expanded population-based screening, which now covers more than 600 districts, with more than 110 million people screened since June 2021. WHO last year released new guidelines on the pharmacological treatment of hypertension in adults, which countries continue to integrate into PHC services. The six modules of the WHO HEARTS technical package – healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines, risk-based management, team-based care, and systems for monitoring – provide a strategic approach to improve cardiovascular health in all countries of the Region and must be harnessed and applied to maximum affect.
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The Region has four priorities areas of action. First, reducing modifiable risk factors. Unhealthy diets that include excessive salt and fat, and which lack adequate fruit and vegetables, are a major cause of hypertension, as is inadequate physical activity and consumption of tobacco and alcohol. Among other interventions, increased taxation of unhealthy products can limit consumption and promote healthier choices. Increased access to green and healthy spaces can facilitate physical activity. Second, enhancing awareness. In many cases, hypertension has no warning signs or symptoms. All adults must therefore have their blood pressure measured on a regular basis, including at every health care visit. Third, fully implementing the WHO HEARTS technical package in all PHC facilities. Specific focus must be put on increasing the capacity of frontline health workers, including in the provision of healthy lifestyle counselling. Fourth, ensuring that in all countries of the Region, hypertension control is included in UHC benefit packages. To do this, policy makers may need to refine financing patterns, exploring innovative solutions.
Accelerated action to prevent, detect and control hypertension cannot and must not wait. Hypertension disproportionately impacts low- and middle-income countries, affecting not just health but all areas of social and economic development. In the ongoing COVID-19 response, and the recovery that will follow, it is incumbent on all stakeholders to maximise health and well-being, leveraging every opportunity. On World Hypertension Day, WHO reiterates its commitment to support all countries of the Region to reduce premature mortality from NCDs by one third by 2030 – the Sustainable Development Goal target – and to engage and empower all people of all ages to live longer, healthier lives.