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Taming the world’s first killer: high blood pressure

High blood pressure is the leading killer in the world – and will kill more people, including more young people, than Covid-19 (and, in usual years, more than all other infectious diseases combined). High blood pressure can be prevented, primarily by reducing dietary sodium, and is effectively treated with safe and inexpensive drugs.
But overall we are doing terribly on controlling blood pressure. Less than 1 in 7 people with high blood pressure, an abysmal 14%, have it controlled. It is, frankly, pathetic – and kills millions of people a year. It is the single most important healthcare intervention for adults to save lives, and we get it done less than once in 7 (and, in the United States, with a health care system of 4 trillion people). dollars, we get there less than half the time, although it is the intervention that can save more lives than any other healthcare intervention in the United States!)
Elegant studies by scientists at the University of Oxford prove that for every 20 point increase in systolic blood pressure (the larger number “on top”), the death rate from cardiovascular disease doubles. Plus, it starts at 115/75 blood pressure – well below the usual level that we are treating, or toward which we are aiming for treatment.
But showing that less is better has not proven that lowering more is better. This is where the incredibly important study of the Systolic Blood Pressure Intervention Trial (SPRINT), started in 2010. It’s one thing to prove (as did Dr Sarah Lewington of ‘Oxford) that low blood pressure correlates with a lower risk of death, but another to prove that lowering blood pressure further saves more lives.

Lower blood pressure reduces the risk of death, but how far do we need to go? This is the big news of the results of the SPRINT study which have just been published. They prove that a lower value is better and that setting a blood pressure goal lower than the standard treatment goal has prevented many more deaths.

The SPRINT study also showed that despite more side effects (much less dangerous than a heart attack or stroke), intensive blood pressure treatment to achieve the low blood pressure goal is safe. even for the elderly. More intensive treatment prevented more heart attacks, strokes and deaths.

Based on the SPRINT study, many guidelines now recommend that some high-risk patients with hypertension aim for systolic blood pressure below 130 rather than the standard target of 140. (SPRINT aimed for an even lower target of 120 / 80.)

But the biggest implication: we have to do a lot better to get people under 140/90. For years, doctors feared lowering their patients’ blood pressure to levels they thought were too low and potentially dangerous. Now it is proven that “going over” the 140/90 target is not just something that will not hurt the patient – it may well save their life.

The death rate for those treated with a blood pressure target below 120/80 was 27% lower than the death rate for those treated up to the usual target of 140/90. And for every death averted, about two heart attacks are averted in addition to strokes, kidney failure, dementia and more.

Even short-term exposure to low levels of air pollution can increase the risk of cardiac arrest

Now it is also true that interventions other than drugs can be important. Reducing sodium, in particular, can reduce blood pressure and other health problems associated with our overly salty diet. Getting regular physical activity, eating a healthier overall diet, reducing air pollution, and more can make a big difference. But these interventions are best done on a societal basis, at the community level.

That is why, although we should empower and educate patients, we should not expect them to be able to withstand the obesogenic, salty, sedentary and polluted environment in which we live. And even if we could magically improve our diets and our overall environment, there would still be a billion people around the world in need of medication to treat their high blood pressure.

Why are we failing to control high blood pressure? One of the reasons is that we made the treatment too complicated – much more complicated than it should be for optimal results. Over the past four years, Resolve to Save Lives has worked with our global partners to identify characteristics of high performing hypertension control programs around the world; we have summarized the lessons learned in this article and in this graphic.
The WHO HEARTS technical package for improving cardiovascular health simplifies the treatment of hypertension: standard treatment protocols that any health worker can implement, reliable supply of quality-assured drugs, team-based health care, patient-centered services and a strong health information system. This increases the likelihood that patients will achieve and maintain blood pressure control.

Think about it. A study came out last week that could save millions of lives. There hasn’t been a single press article about it. Although this is “only” the final report of a study whose main findings had already been published in advance (because the findings are so important), we were slow to implement these findings. recommendations. It shows that we still have a lot to learn about what we need to focus on to save the most lives.

Resolve To Save Lives partners with countries implementing WHO’s HEARTS program to lower blood pressure. Reducing sodium and treating high blood pressure can prevent 3 million premature deaths each year. Lowering blood pressure can save millions of lives. We know what we need to do, now let’s make it happen.

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