A large global study by the World Health Organization (WHO) and Imperial College London has revealed a disturbing picture of high blood pressure in the world. In about 30 years, the number of people living with hypertension on the planet has doubled. The indices show a jump from 650 million in 1990 to around 1.4 billion hypertensive in 2019 – of this total, around 14% have controlled blood pressure. According to the survey, about half of people do not know they have the disease and remain without proper treatment.
The work involved 1,021 studies, from 184 countries, and 104 million participants covering the period from 1990 to 2019. The results were published this Tuesday (24) in The Lancet, one of the main scientific journals in the world.
Hypertension is a serious disease that causes the death of almost 400 people in Brazil every day, according to estimates by the Ministry of Health. High blood pressure occurs when the values of the maximum and minimum pressure are equal to or exceed 140/90 mmHg (or 14 by 9). The condition causes the heart to exert more effort than usual to distribute blood correctly throughout the body. The disease has no cure, but treatment is essential to reduce risks and increase the quality of life of patients.
Consequences of lack of treatment
Hypertension can go undetected for years, which leads to a large treatment gap. According to the study, about 580 million people with hypertension (41% of women and 51% of men) were unaware of the condition because they were never diagnosed. The analysis also revealed that more than half of the people (53% of women and 62% of men) with hypertension, a total of 720 million individuals, were not receiving adequate treatment.
Cardiologist Helio Castello, from Hospital Alemão Oswaldo Cruz, in São Paulo, explains that the symptoms can go unnoticed, because some people who have hypertension also suffer from other issues that affect health, such as obesity, diabetes, smoking and the impacts of aging .
“Added to this increased pressure, the person often has factors such as obesity, smoking, diabetes. So she has symptoms, such as tiredness, difficulty in carrying out activities or swelling in her legs, but she thinks they are normal”, explains Helio.
Cardiologist Dante Senra points out that the signs of hypertension usually appear only when the pressure rises too high. The main symptoms are chest pain, headache, dizziness, ringing in the ear, weakness, blurred vision and nosebleeds.
According to cardiologist Helio Castello, hypertension significantly increases the risk of other heart diseases, in addition to brain and kidney impacts. “Hypertension increases the risk of heart attack, stroke, kidney failure, loss of vision and the development of aneurysms, among other complications,” he said.
Despite being one of the leading causes of death and illness worldwide, hypertension can be easily diagnosed by measuring blood pressure. The procedure, which can be performed at home or in basic health units (UBSs), must be performed at least once a year by people over 20 years of age. For individuals with a family history of the disease, blood pressure should be measured twice a year.
The treatment is effective and has a wide availability of medicines, freely accessible in Brazil by the Unified Health System (SUS), which also offers diagnosis and follow-up. Experts point out that only the doctor can determine the best method for each patient and that therapy is not always done with the use of medication.
“It is essential to adopt a healthier lifestyle, such as changing eating habits, reducing salt intake, regular physical activity, not smoking, and moderately consuming alcohol,” said Dante.
Based on the results of the study, WHO suggests monthly follow-up after starting or changing antihypertensive medications until patients reach stabilization. For patients with blood pressure under control, WHO recommends follow-up every 3 to 6 months.
“Many people neglect the treatment of hypertension, considering that they have always had high blood pressure and that everything is fine. The disease has future consequences,” adds Juliana Gil de Moraes, a cardiologist at Hospital Sírio-Libanês, in São Paulo.
High blood pressure is on the list of comorbidities included in vaccination against Covid-19. According to a study published in the scientific journal The BMJ, high blood pressure can reduce life expectancy by more than five years.
According to cardiologist Helio Castello, the hereditary factor is responsible for most cases of hypertension. “Those who have close people, such as parents and siblings, with high blood pressure have a greater chance of developing hypertension earlier,” he says.
In addition to the hereditary issue, behavior is one of the main factors related to the development of high blood pressure. Habits such as excessive consumption of salt, unbalanced diet and sedentary lifestyle contribute to the development and aggravation of the disease.
According to the cardiologist, smoking, obesity, alcohol consumption, high cholesterol levels are also risk factors for high blood pressure, as well as stress and consumption of medications such as steroids and anti-inflammatory drugs.
income x hypertension
The study published in the Lancet reveals a shift in disease burden across countries. While the rate of hypertension has decreased in rich countries, there has been an increase in many low- and middle-income countries.
For the cardiologist Helio Castello, changes in the epidemiological scenario are mainly associated with the inclusion, in low- and middle-income countries, of habits common to developed countries. “People put into their routine things that often came from developed countries. Fast food, for example, started in the most developed countries, mainly in the United States. Both Brazil and other countries ended up assuming this and not using healthier food”, says Helio.
According to the expert, the increase in the implementation of technological mechanisms, such as escalators, treadmills and elevators, also tends to reduce physical effort in daily activities. “All of this is great, but it made people do less physical activity, less walking. Today, people travel more by bus or car to cover short distances”, he adds.
Countries such as Canada, Peru and Switzerland had one of the lowest prevalences of hypertension in the world in 2019, while some of the highest rates were seen in the Dominican Republic, Jamaica and Paraguay for women and Hungary, Paraguay and Poland for men.
With information from Leonardo Lopes, from CNN.