WHO Report on global impact of High BP

Table of Contents

Context: The World Health Organization (WHO) has released its first-ever report on the devastating global impact of high blood pressure along with recommendations to tackle the same.

Key observation of the Report:

Global Impact: Hypertension affects a significant portion of the world’s population, with 1 in 3 adults worldwide having high blood pressure.
Undertreatment: Approximately 4 out of every 5 people with hypertension are not adequately treated. If countries can scale up coverage, 76 million deaths could be averted between 2023 and 2050.
Growing Problem: The number of people living with hypertension has doubled between 1990 and 2019, reaching 1.3 billion individuals.
Global Awareness: Nearly half of people with hypertension globally are currently unaware of their condition. This lack of awareness is especially prevalent in low- and middle-income countries.
Risk Factors: Hypertension can result from both genetic factors and modifiable risk factors such as a high-salt diet, physical inactivity, and excessive alcohol consumption.
Health Consequences: Hypertension can lead to severe health problems especially Non Communicable Diseases (NCDs) that include stroke, heart attack, heart failure, kidney damage,

About Hypertension:

Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body.
Hypertension occurs when blood pressure is too high.
It is defined as having systolic blood pressure level greater than or equal to 140 mmHg or diastolic blood pressure level greater than or equal to 90 mmHg or/and taking anti-hypertensive medication to lower his/her blood pressure.

Hypertension Burden in India:

Prevalence:

Hypertension is the most important non communicable disease risk factor in India.
Southern States have a higher prevalence of hypertension than the national average.
- Kerala (32.8% men and 30.9% women) has the highest number followed by Telangana.
21.3% of women and 24% of men aged above 15 have hypertension in the country.

Recommendations of the Report:

Scale-Up Coverage: Countries are urged to scale up coverage of hypertension treatment to reach more individuals with high blood pressure.
Primary Healthcare: Effective hypertension management should be integrated into primary healthcare systems, making it accessible to a broad population.
Medication Regimens: Simple, low-cost medication regimens should be made available and affordable to those with hypertension.
WHO’s HEARTS Package: WHO’s HEARTS technical package for cardiovascular disease management in primary healthcare and guidelines for the pharmacological treatment of hypertension in adults should be implemented for proven and practical steps for hypertension care.
Team-Based Care: Collaboration among healthcare teams is encouraged to adjust and intensify blood pressure medication regimens per doctor orders and protocols.
Patient-Centered Services: Reducing barriers to care through easy-to-take medication regimens, free medications, close-to-home follow-up visits, and accessible blood pressure monitoring can improve patient outcomes.
Information Systems: Simple information systems should be developed to facilitate rapid recording of essential patient-level data, reducing healthcare worker data entry burden and supporting rapid scale-up while maintaining or improving the quality of care.

Growing Prevalence of NCDs in India:

Understanding Non-Communicable Diseases:

Noncommunicable diseases (NCDs) are chronic diseases that tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioural factors.
These diseases are not contagious and cannot be spread from person to person.
The main types of NCDs include cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes.

Causes and Consequences of NCDs:

Causes:

NCDs have multiple causes, including genetic, physiological, environmental, and behavioural factors.
However, the rise of NCDs in recent years has been largely driven by certain risk factors, such as tobacco use, harmful use of alcohol, unhealthy diet, physical inactivity, overweight/obesity, raised blood pressure, raised blood sugar, and raised cholesterol.
These risk factors are often linked to lifestyle choices and environmental factors.
- For example, tobacco use and harmful use of alcohol are behavioural risk factors that are closely linked to addiction and social factors.
- Unhealthy diet, physical inactivity, and overweight/obesity are also behavioural risk factors that can be influenced availability of healthy food options.
Consequences:
- NCDs can lead to disability, reduced quality of life, and premature death.
- The socioeconomic costs associated with NCDs are also substantial and include direct costs related to healthcare, as well as indirect costs related to lost productivity and reduced economic growth.
- The disease kills 7 out of 10 people globally from risk factors like tobacco, alcohol, unhealthy diet, physical inactivity and air pollution.
- Apart from deaths, NCDs take a heavy toll on economies, cutting down people in their most productive years.

WHO’s Report on Non-Communicable Diseases:

WHO recently released a report titled “Invisible Numbers — The True Extent of Non-communicable Diseases and What To Do About Them”.

Key Highlights of the Report:

NCDs are collectively responsible for almost 70% of all deaths worldwide, with almost three-quarters of all NCD deaths and 82% of premature deaths occurring in low- and middle-income countries.
Every two seconds, one person under the age of 70 dies of a non-communicable disease (NCD).
Globally, one in three deaths (17.9 million a year) are due to cardiovascular diseases (CVDs).
Two-thirds of people with hypertension live in low- and middle-income countries, and almost half of them are not aware they have it.
Diabetes causes one in 28 deaths (2.0 million people a year), and more than 95% of diabetes cases globally are of type 2 diabetes.
Cancer causes one in six deaths (9.3 million people a year), and 44% of cancer deaths could have been prevented or delayed by eliminating risks to health.
70% of deaths due to chronic respiratory diseases could have been prevented or delayed by eliminating risks to health.
Covid-19 has highlighted the links between NCDs and infectious disease, with serious impacts on NCD care, and 75% of countries reported disruption to essential NCD services in the early months of the pandemic.
Only a handful of countries are on track to meet the Sustainable Development Goal target to reduce early deaths from NCDs by a third by 2030.
- SDG 3 entails to Ensure healthy lives and promote well-being for all at all ages.

The “India: Health of the Nation’s States” study report:

The report by the Indian Council of Medical Research (ICMR) observed that:

The proportion of deaths due to NCDs has increased from 37.9% in 1990 to 61.8% in 2016.
The leading causes of death due to NCDs in India are cardiovascular diseases, chronic respiratory diseases, cancer, and diabetes.
NCDs are responsible for 55% of the total disability-adjusted life years (DALYs) in India, which is a measure of the overall disease burden.
The burden of NCDs is higher in the more developed states of India compared to the less developed ones.
Unhealthy lifestyle choices such as tobacco and alcohol use, unhealthy diets, and physical inactivity are the major risk factors for NCDs in India.
The study highlights the need for preventive measures such as promoting healthy lifestyle choices and improving access to healthcare services.

Initiatives to deal with NCDs:

Global Initiatives: Some of the global initiatives to deal with NCDs include:

The Sustainable Development Goals (SDGs): The SDGs include a target to reduce premature mortality from NCDs by one-third by 2030 (SDG 3.4).
WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020: This action plan aims to reduce premature mortality from NCDs by 25% by 2025 and includes a set of nine global targets.
WHO Framework Convention on Tobacco Control: This international treaty aims to reduce tobacco consumption and the related harm to health.
United Nations High-Level Meeting on NCDs: This meeting, held in 2018, focused on accelerating progress on the prevention and control of NCDs and called for increased political commitment and action.
The NCD Alliance: This is a global network of civil society organizations working to prevent and control NCDs. It advocates for policy change and increased investment in NCD prevention and management.

India’s Initiatives:

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented under the National Health Mission.
- The programme focuses on strengthening infrastructure, human resource development, health promotion & awareness generation for prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the NCDs.
The Central Government is implementing the Strengthening of Tertiary Care Cancer facilities scheme to support the setting up of State Cancer Institutes (SCI) and Tertiary Care Centres (TCCC) in different parts of the country.
Fit India movement is implemented by the Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by the Ministry of AYUSH.
Oncology in its various aspects has a focus in case of new AIIMS and many upgraded institutions under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).
Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level.
Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendayal outlets have been opened at 159 Institutions/Hospitals with an objective to make available Cancer and Cardiovascular Diseases drugs and implants at discounted prices to the patients.
Jan Aushadhi stores are set up by the Department of Pharmaceuticals to provide generic medicines at affordable prices.