It’s common knowledge that high blood pressure is not good for your health and the statistics show either you have high blood pressure or you know someone who does. However, as I’ve been diving into the research recently, I was really struck by the magnitude and impact of this global health disaster. For example:

  • High blood pressure kills tens of millions of people every year
    • High systolic blood pressure was the leading risk factor in the 2017 Global Burden of disease study, accounting for 10.4M deaths that year. According to the study, hypertension is a higher risk factor than smoking, high fasting glucose, and high body mass index.
  • The indirect costs of uncontrolled high blood pressure is estimated to be $3.6T
    • A 2009 study showed “sub-optimal” BP is estimated to have cost $370B in 2001, which is 10% of total global healthcare spend. Over a 10-year period, elevated blood pressure may cost nearly one trillion dollars globally in health spending, if current blood pressure levels persist. Indirect costs could be as high as $3,600,000,000,000 annually (that’s $3.6 trillion with a T).

It’s worth diving into this topic further to put some numbers to the scope of the problem and discuss the impact its having around the world. But first some quick definitions from the World Health Organization:

  • Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.
  • Blood pressure is written as two numbers. The first number (systolic) represents the pressure in blood vessels when the heart contracts or beats. The second number (diastolic) represents the pressure in the vessels when the heart rests between beats.
  • Hypertension (high blood pressure) is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥130 mmHg and/or the diastolic blood pressure readings on both days is ≥80 mmHg.
Blood pressure stages

Source: https://www.webmd.com/hypertension-high-blood-pressure/guide/diastolic-and-systolic-blood-pressure-know-your-numbers#1

Hypertension affects over one billion people worldwide and that number is growing

According to the World Health Organization, an estimated 1.13 billion people worldwide have hypertension, most (two-thirds) are living in low- and middle-income countries. In the US, more than 100 million Americans have high blood pressure. That means nearly half of US adults (46%) are now dealing with hypertension.

The number of people living with high blood pressure worldwide has doubled over the last 40 years, with the problem shifting from wealthy western countries to the developing world over that timeframe. And the growth of the problem seems to be accelerating. By 2025, over 1.5B people are expected to have hypertension – approximately 30-50% growth from 2000.

High blood pressure kills tens of millions of people every year

High systolic blood pressure was the leading risk factor in the 2017 Global Burden of disease study, accounting for 10.4M deaths that year. According to the study, hypertension is a higher risk factor than smoking, high fasting glucose, and high body mass index. 

It’s worth saying that again – high blood pressure is THE PRIMARY risk factor in all global disease. In other words, if you reduce hypertension, you reduce the impact of many different diseases that kill tens of millions of people every year. 

Hypertension is a significant risk factor for stroke, heart failure, coronary artery disease, diabetes and kidney disease. In fact, high blood pressure is the leading cause of heart disease and stroke, which kills 7.5M people worldwide per year; that is at least 45% of deaths due to heart disease and 51% of deaths due to stroke.

In addition hypertension has impacts on brain health and cognitive function as well:

“Experts have long recognized the relationship between vascular brain pathology and syndromes of cognitive decline and dementia [Snowdon et al., 1997], but this notion has only recently gained significant momentum in the scientific community or in public health efforts.” Source: Mind Your Risks 

So it’s not surprising that recent research has shown that lowering blood pressure can impact have a positive impact on brain health.

“New research compares intensive blood pressure control with standard blood pressure management and finds that the former correlates with a lower chance of developing white matter lesions later in life.”

High blood pressure also costs a lot of money

The total costs associated with high blood pressure in 2011 in the US were $46 billion in health care services, medications, and missed days of work, according to the CDC. The problem has only grown since then. The American Heart Association now estimates direct and indirect cost of high blood pressure in 2013 to 2014 (annual average) was $53.2 billion (MEPS, NHLBI tabulation).

When you look at the problem on a global scale, a 2009 study showed “sub-optimal” BP is estimated to have cost $370B in 2001, which is 10% of total global healthcare spend. Over a 10-year period, elevated blood pressure may cost nearly one trillion dollars globally in health spending, if current blood pressure levels persist. Indirect costs could be as high as $3,600,000,000,000 annually (that’s $3.6 trillion with a T).

On the flip side, that same study estimated health care savings from effective management of blood pressure projected at roughly $100 billion per year.

And the problem is largely uncontrolled 

Hypertension is particularly scary because it has no physical symptoms. That’s why it’s often called the “silent killer”. However, that also leads to complacency, whether someone knows they have high blood pressure or not. 

According to the CDC, hypertension affects nearly one third of U.S. residents aged ≥18 years (approximately 75 million persons), and in approximately one half of adults with hypertension (nearly 35 million persons), it is uncontrolled. Among these 35 million U.S. residents with uncontrolled hypertension:

  • 33% (11.5 million people) are not aware of their hypertension, 
  • 20% (7 million people) are aware of their hypertension, but are not being treated for it, and 
  • Approximately 47% (16.1 million persons) are aware of their hypertension and being treated for it, but treatment (by medication and/or lifestyle modification) is not adequately controlling their blood pressure.

Two things worth pointing out about that data: 1) fully one-third of Americans with high blood pressure don’t even know it, and 2) half of US adults with hypertension DO NOT have it under control. 

High blood pressure 1-in-7

Source: https://www.resolvetosavelives.org/hypertension/

 

The problem is even worse around the world. The PURE study in 2013 included data from over 142,000 people globally and found: 

  • 41% had hypertension 
  • 46.5% of those with hypertension were aware of it

So more than half the people with hypertension don’t even know they have it. If you combine that with the WHO data showing over 1 billion people with hypertension, that means over 500 million people around the world are living with a “silent killer”.

We clearly have a global health epidemic in progress with high blood pressure. In the next post, we’ll discuss how to address these problems. In the meantime, here’s a good summary of the problem from the American Heart Association:

AHA heart stroke stats