Hypertension Impact and Prevalence

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Hypertension and its Global Impact in the 21st Century
Jafar Al-Said, M. B. ChB. MD. FASN. FACP.
Chair of Internal Medicine
Nephrology and Internal Medicine Consultant.
Bahrain Specialist Hospital
e-mail: jafaralsaid@gmail.com.

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Introduction:
Hypertension is the most common global cardiovascular risk factor. According to
the current statistics, hypertension is affecting around 39% of the global population. (1) The
World Health Organization (WHO) 2014 annual report have quoted cardiovascular disease
as the main cause of mortality from non-communicable diseases, among which
hypertension accounts for 45% of the total mortality. (2) In spite of its large impact, in most
of the cases, hypertension could be managed by using combined antihypertensive
medications with lifestyle modification. In fact, all guidelines emphasize the point that
reducing blood pressure using any antihypertensive medication could effectively decrease
its health impact. Moreover, implementing healthy lifestyle alone in many circumstances
has proven to reduce hypertension prevalence and could effectively decrease cardiovascular
mortality and morbidity. (3) Thus, lifestyle adjustment will eventually reduce the burden
of hypertension on personal as well as on governmental levels. (1) This review will discuss
the current and future impact of hypertension in a global as well as on regional aspect. It
this article we review the prevalence of hypertension and its economic impact during the
coming is century. Accordingly, suitable future planning and preventive strategies would
be highly recommended to encounter the large increase in hypertension prevalence and its
economic burden.

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Hypertension Global Prevalence:
The WHO global health 2014 report stated that hypertension prevalence is 45% in
Africa, and 41% in Europe and Eastern Mediterranean regions. It affected 38% of the
population in the Western Pacific Region, 36% in South East Asia, and 35% in the America
region. (1, 2) Thus the global average will be around 39%. This clarifies the extent at which
Hypertension impact cardiovascular health worldwide. This prevalence exceeds that of
other cardiovascular risk factors. Diabetes, as an example, affects 171 million individuals
around the world. The prevalence will rise to reach 366 million in the year 2030. (7)
Coronary artery disease affects 6.8% of the global population. (8) Stroke, on the other hand,
affect 5% of the worldwide population. (8) Obesity and Hyperlipidemia affects around one
third of the global population. (9, 10)
Hypertension prevalence in the gulf region:
The regional data from the Gulf, according to WHO 2014 annual report revealed
that HTN in Bahrain is prevalent among 28% of the population. In Kuwait the prevalence
is 20%. In UAE HTN affect 19% of the population. While 25% of the whole population in
Saudi Arabia, Qatar, Oman, and Yemen have HTN. In Iraq and the Islamic Republic of Iran
the prevalence is around 24%. With a total estimated population in the region of
180.481.000, and a mean HTN prevalence around 24% the total number of patients will be
around 45.120.250 patients. Taking in consideration the estimated population growth,
assuming the same prevalence of HTN, the total number of patients in the year 2050 in the
gulf regions will be around 90.240.500 patients. This gives a clear image on the extent of

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the disease and the impact it will have on the region and the increased expenses that will be
needed for the management. (1) Figure (1)
Population growth and the future expected prevalence of Hypertension:
The current global population is 7.24 billion individual living in six continents. (11)
According to the global hypertension prevalence mentioned above, the number of affected
patients are 2.8 billion. The United Nations (UN) had predicted that the global population
would reach 16 billion on the highest estimate or 10 billion on the lowest expected
population growth by the end of this century. This would mean that we will have to manage
between 4-6 billion hypertensive patients in the year 2100. (12) (Graph 1)
According to the World Bank classification the prevalence of hypertension is
inversely related to the country socioeconomic status. To further complicate the situation,
it is known that the major population growth will take place between the underdeveloped
countries. (13) In other words, larger increases in hypertensive patients will take place in
lower socioeconomic and developing countries were the diagnosed and treatment is already
suboptimal. Thus, low and middle income countries would have to face the major burden
as compared to the developed countries.
Hypertension burden on individual health:
In 2012 non-communicable diseases were responsible for the mortality of 38 million
patients around the world. This constituted 68% of the global morality. During the same
time more than 16 million deaths were considered premature occurring among patients

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under 70 years of age. Around 82% of the premature deaths were recorded in low and
middle income countries. (2) Hypertension and its complications per se, accounted for
about 45% of the non-communicable disease mortality. (4)
Certain epidemiological measures have shown to be effective in reducing
cardiovascular diseases. As an example, decreasing salt intake had proven to decrease
cardiovascular mortality and morbidity among few countries. Reducing the daily salt
consumption to 6 gm could prevent 2.5 million cases of stroke and coronary artery disease
annually.(5) Reducing salt utilization by 15% in low and middle income countries over 10
years would save more than 8.5million lives.(6) Knowing that 80% of the salt we consume
on daily basis comes from processed readymade food, taking an active approach is required
towards persuading the food industry, through monitoring, education, incentives to reduce
salt in food preparation could be one successful aspect in decreasing hypertension
prevalence. Successful policies have been implemented in several countries such as the
United Kingdom. It was a pioneer in introducing 20-30% reduction in salt consumption
over several years. The result has annually saved 6000 lives and 1.5 billion pounds in
treating cardiovascular diseases and there complications. Due to the proven benefit of salt
reduction, the WHO has considered 30% salt reduction as the target number 4 among nine
other global health goal targets to reduce non-communicable diseases by the year 2025. (2)
World Health Organization recommendations:
After recognizing the magnitude of the problem in 2013, the WHO released the
second health report focusing on prevention and control of non-communicable diseases.

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The report specifically addresses Hypertension and its effect on global health. Being one
of the main causes of non-communicable disease mortality, and taking into consideration
the effective prevention and simple management of Hypertension as compared to its
complications, a global action plan was proposed. Governmental health policies and plans
were suggested to prevent and control the disease burden. Spending money on
implementing tight screening and preventive health plans would eventually lower the
annual governmental health expenditure as compared to treating the disease with its
consequences. (14, 2)
Conclusion:
Hypertension will affect 4-6 billion individual around the world by the end of this
century. Management of patients coming to our clinic or admitted in our hospitals is not
enough to reduce or control the disease burden. In view of the possible and successful
preventive measures to decrease its impact and the effective treatment strategies to decrease
its complications, we will need more focused efforts towards implementing preventive
plans. If we do not start proactive planning and undertake serious actions we will be facing
a tsunami that will hit all nations on six continents. The magnitude of cardiovascular
complications and consequences would cost us lives and huge economic losses. Urgent and
active unified action is highly recommended.

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References:
1. World Health Organization – Non-communicable Diseases. (NCD) Country Profiles,
2014. http://www.who.int/nmh/publications/ncd-profiles-2014/en/
2. World Health organization. Global Status Report on non-communicable diseases 2014.
http://www.who.int/nmh/publications/ncd-status-report-2014/en/
3. Mancia G., Fagard R., Narkiewicz K. eta.The Task Force for the management of arterial
hypertension of theEuropean SocietyofHypertension (ESH) and of the EuropeanSociety
of Cardiology (ESC) 2013 ESH/ESC. Guidelines for the management of arterial
hypertension. Journal of Hypertension 2013, 31:1281–1357.
4. World Health organization. Causes of death 2008. Ischemic heart disease mortality rates
and cerebrovascular disease mortality rates. Age standardized, per 100000.
5. He FJ, MacGregor GA. A comprehensive review on salt and health and current
experience of worldwide salt reduction programs. J Hum Hypertens 2009; 23: 363–84.
6. Asaria P, Chisholm D, Mathers C et al. Chronic disease prevention: health effects and
financial costs of strategies to reduce salt intake and control tobacco use. Lancet 2007;
370: 2044–2053.
7. World Health Organization. Country and Regional Data on Diabetes.
http://www.who.int/diabetes/facts/world_figures/en/.
8. World Health Organization. Global Burden of Coronary Heart Disease.
http://www.who.int/cardiovascular_diseases/en/cvd_atlas_13_coronaryHD.pdf?ua=1.
9. World Health Organization. CV Risk factors: Obesity.
http://www.who.int/cardiovascular_diseases/en/cvd_atlas_09_obesity.pdf?ua=1.
10. World Health Organization. CV risk factor: Lipids.
http://www.who.int/cardiovascular_diseases/en/cvd_atlas_06_lipids.pdf?ua=1.
11. Population Reference Bureau. World Population Data sheet. http://www.prb.org/
12. Wikipedia. Projections of population growth.
https://en.wikipedia.org/wiki/Projections_of_population_growth.
13. World Population Bureau. 2013 world population data sheet.
http://www.prb.org/pdf13/2013-population-data-sheet_eng.pdf.
14. World Health organization. A global brief on hypertension. WHO/DCO/WHD/2013.2

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Figure (1): Population count in 2014 and the prevalence of HTN in the Gulf countries.

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Graph 1. Hypertension Prevalence during the 21st century