Once considered a disease of the affluent, hypertension now affects a third of all adults. The WHO wants nations to get organized to combat it.

THE WORLD HEALTH Organization (WHO) is taking on the world’s worst killer, laying out its first plan to conquer hypertension—a level of high blood pressure that affects one in every three adults globally. That figure has doubled since 1990. It’s now up to 1.3 billion people.

High blood pressure might sound like a disease of rich nations, but in a report released today during the United Nations General Assembly, the WHO said that three-fourths of people living with hypertension reside in low- and middle-income nations. Nearly half of them have no idea they have the condition, which causes heart attacks, kidney disease, and stroke. Four-fifths of them, including both people with a diagnosis and those who don’t know they are affected, aren’t getting adequate treatment to control it.

If that could be improved, the agency said, 76 million lives could be saved between now and the year 2050. “There are some health issues for which we lack knowledge or effective tools,” said Tedros Adhanom Ghebreyesus, the WHO’s director general—who has been open about controlling his own high blood pressure with medication—during a briefing in New York City. “Hypertension is not one of them. We have the tools. Every country can do more to use those tools.”

Technically, hypertension is an exacerbation of high blood pressure. A blood pressure monitor displays two numbers: the pressure inside arteries when the heart beats, followed by the pressure between beats. A measurement of 120/80 mmHg (indicating the movement of a column of mercury in the monitor) is considered ideal. When the first figure rises above 140 or the second nudges above 90, that’s hypertension: the point at which the force of the blood can damage arteries and reduce the amount of oxygen reaching the heart.

Blood pressure rises for a variety of reasons, which may be different around the world: eating a lot of salt, drinking alcohol, using tobacco, breathing polluted air, and not exercising. The remedies are simple, though not necessarily easy to scale: fixing diets, providing affordable medications, and building out health care and information systems so that people can be diagnosed and monitored without a lot of effort on their part.

“The bottom line here is that the world's most deadly condition is also the most neglected,” said Tom Frieden, a former director of the US Centers for Disease Control and Prevention and president and CEO of the health nonprofit Resolve to Save Lives (which collaborates with the WHO), in a separate briefing earlier. “For more than half a century, treatment of high blood pressure has been the standard of care in higher income countries. It's way past time for it to become the standard of care for every person in the world.”

The WHO plan calls for countries to make controlling hypertension a government priority, something that health ministries write plans for and health care systems emphasize. (The accompanying report offers Canada and South Korea as examples; those countries got hypertension under control in more than half the people diagnosed with it.) After that, the agency recommends uniform protocols for diagnosis and treatment, down to the order in which to try certain drugs and the doses to use. It also outlines how to organize outreach workers and paraprofessionals to increase the number of people working on the problem while keeping costs down. Finally, it describes standards for governments buying the needed drugs—which are all inexpensive generics—and for creating data systems to track patients and treatments.

Experts not affiliated with the WHO’s project said the prevalence of hypertension around the globe is a clue that it is a disease of modernity. “I’m from Uganda, and when I was growing up in the ’80s, hypertension used to be considered a disease of the affluent. But that is no longer the case,” says Annet Kirabo, an associate professor at Vanderbilt University Medical Center who leads a hypertension research project in Zambia. “Africa is being Westernized. Some of the diets prevalent here that contribute to hypertension and other cardiovascular diseases are common back there in sub-Saharan Africa also.”

While salt consumption is a major factor in the rise of high blood pressure—and may be particularly dangerous in Black populations, who share genetic mutations making them more sensitive to salt—other factors influence it as well. Some may be more common in emerging-economy nations, such as a loss of access to traditional diets as people migrate to cities, an inability to exercise safely, and an exposure to fine particulates from burning fossil fuels. “This is very complex in developing countries,” says Sanjay Rajagopalan, a cardiologist and director of the Cardiovascular Research Institute at the Case Western Reserve University School of Medicine. “Urban migration, changes in food and culture, access to care, high levels of pollution—all of these are synergistic and result in much higher levels of hypertension.”

In its plan, the WHO makes the point that battling hypertension ought to be a priority for nations not just out of compassion, but to save money as well. More than one-third of deaths from hypertension occur in people under age 70, meaning that their income is lost both to their families and as a contribution to a country’s GDP. In one estimate cited by the agency, spending $1 on hypertension control recovers $18 down the road.

It may be a big ask, as the world comes out of Covid, to recommend that societies focus on another overwhelming health problem. But it may also be the right moment to do so. Though Covid killed almost 7 million people worldwide, diseases that are not caused by infectious organisms kill 41 million people every year. And unlike Covid, hypertension is neither a mystery nor a shock; the condition is well understood, and there are affordable drugs that treat it.

But as the new plan proposes, it has not been taken seriously enough. “In general, noninfectious diseases have been neglected in the majority of the world,” says Gene Bukhman, a cardiologist who directs the Program on Global Noncommunicable Disease and Social Change at Harvard Medical School. “They’ve been treated as emerging problems, when really they’ve been endemic problems for decades.” Controlling hypertension, in other words, shouldn’t take a program of discovery—just an effort of will.