Hypertension—Together,let’s defeat the Silent Killer

Hypertension is the leading cause of preventable premature deaths. Globally, around 1.4 billion adults in the 30-79-year age group are estimated to have the diagnosis of hypertension. ¹ The prevalence is very high in many countries, including India. In India, the pooled prevalence is 27.2% (95% CI: 23.2%-31.3%). ² However, nearly half of the people with hypertension (44%) are not aware that they have high blood pressure. ¹ Even when the diagnosis has been made and treatment has been initiated, just one-fourth of them (23%) have their blood pressure under control. ¹ In spite of the advances in diagnostics and therapeutics, hypertension continues to be a silent killer due to the asymptomatic nature of the clinical presentation, late diagnosis, inequities in access to appropriate care, and non-adherence to treatment.

Hypertension is no longer an illness of adults. The rising trend of hypertension in children and adolescents is a major concern. Recent studies estimate that the prevalence of hypertension among children and adolescents in the 3-19-year age group is 4.3%. This is nearly two times, compared to the prevalence estimates for the year 2000. ³ Children who have high blood pressure carry two to three times the risk of heart disease and renal disease when they become adults. ⁴ Further research is needed on the diagnostic approaches and criteria to define childhood hypertension.

Community engagement is a key intervention in the prevention and control of hypertension. The World Health Organization and the health service departments of individual nations aim to raise awareness on the basics of hypertension and its prevention and control, through community-level interventions. This is the main agenda in observance of World Hypertension Day on May 17. This year’s theme is “Controlling Hypertension Together: check your blood pressure regularly, defeat the silent killer.” The focus of the theme is on monitoring blood pressure through regular checking, promoting healthy diets, ensuring physical activity, avoiding tobacco and alcohol intake, and adherence to medications. ¹ Equity must be attained through making primary health care services available universally and including hypertension prevention and control services as a routine activity in every division of the health system.

There are many recent advances in therapeutics, such as newer antihypertensive drugs that act on physiological pathways other than those targeted by conventional drugs. ⁵ Examples are small interfering RNA agents that inhibit angiotensinogen synthesis and nonsteroidal mineralocorticoid receptor antagonists. Despite all these developments, right now, only one in four persons with hypertension has blood pressure under control. We need to strengthen research on how to address risk factors, promote primary prevention, make access to early detection and treatment universal, and ensure adherence to treatment and the prevention of complications. Policy-level initiatives are needed to increase the production and distribution of vegetables and fruits, developing and maintaining a facilitating environment for physical activity, and legal measures to reduce trans-fat production and sale. Best practices from regions need to be disseminated in the public domain so that similar interventions are modified and replicated in other areas. We need context- and setting-specific solutions to improve adherence to treatment and overcome therapeutic inertia. There is a big scope for implementation research in this area. In this context, the Indian Journal of Clinical Medicine announces a special issue to highlight the innovations in the prevention and control of hypertension, and the details will be announced soon.