The Lancet CommissionsA call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension
Section snippets
Executive summary
Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world.
The aim of the Lancet Commission on hypertension is to identify key actions to
Size of the problem
Because hypertension rarely causes symptoms in the early stages, it is a silent killer, causing accelerated atherosclerosis, damage to major organs, disability, and death from cardiovascular disease.18 Approximately one in four adults have hypertension (when defined as blood pressure greater than 140 mm Hg systolic or 90 mm Hg diastolic) and by 2025, hypertension is projected to affect more than 1·5 billion people worldwide.19 In recent decades, there has been an epidemiological shift in the
Current evidence, problems, and perspectives
It is striking that all blood pressure guidelines1, 53, 70 agree that individual lifestyle modification is the cornerstone of prevention and is the first line of treatment. However, two important challenges emerge in terms of clinical hypertension guidelines. First, the guidelines are written mostly by clinicians, such as cardiologists and nephrologists with training and experience in the clinical management of hypertension and cardiovascular disease, who therefore focus on individual patient
Introduction to diagnosis and evaluation
Improved characterisation of patients, including accurate diagnosis, is the primary requisite to guide therapy, management, and follow-up in hypertension. A (more) specific diagnosis of hypertension is fundamental to tailor therapy (eg, non-pharmacological, drug class or classes, and dose). Failures or weaknesses in this diagnostic process can result in inappropriate treatment, potentially leading to increased adverse drug reactions (particularly in older individuals), inappropriate
Current evidence and problems
There is strong evidence that blood-pressure-lowering drugs are beneficial for the prevention of major events such as stroke, myocardial infarction, kidney failure, and cardiovascular death. Compelling data are few, however, concerning the role of antihypertensive treatment—in middle-aged and older individuals—to prevent dementia or in slowing the progression of cognitive impairment.
In early trials into diastolic and systolic–diastolic hypertension, blood-pressure-lowering drugs reduced, on
Introduction to empowerment
Education and empowerment are related tools that offer great potential to improve the global management of elevated blood pressure. Abundant evidence suggests that early health education improves outcomes in terms of primordial prevention; education can also be tailored to improve interactions between patients, doctors, health-care providers, pharmacists, and key participants in the management of hypertension to maximise its effectiveness.
Patient empowerment more specifically refers to the
The economics of managing blood pressure
Blood pressure control was identified as a leading target of the 2013 WHO Global Monitoring Framework to reduce deaths from non-communicable diseases by 25% by 2025.446 Elevated blood pressure is a main indicator of high risk for cardiovascular disease, and many premature deaths can be averted cost-effectively through community and clinic-delivered interventions. Because most deaths related to non-communicable disease are projected to occur in the future in low-income and middle-income
Setting the scene for a multifaceted approach
10·4 million people are estimated to die each year because of elevated blood pressure.65 The costs in terms of morbidity and mortality, as well as economic and societal costs, are substantial. The causes of hypertension are complex, as are the solutions. Hypertension is often the product of a lifelong interplay of individual and environmental factors, starting even before birth. Thus, the approach to this growing public health problem is multifaceted. First, there is a need to respond
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