After the World Health Organization released a report finding that high blood pressure (hypertension) is a more serious worldwide problem than previously realized, a Northern Virginia cardiologist outlined recent advances in the field — but added that the old methods remain tried and true.
The report was an aggregation of the WHO’s observations over the last 20 years, and the main finding showed that between 1990 and 2019, the number of people with hypertension worldwide rose from 650 million to 1.3 billion.
“They suspect that if you include all the people who don’t know they have hypertension, that one in three adults in the world have hypertension today,” says Dr. Ameya Kulkarni, an interventional cardiologist for Kaiser Permanente.
“Now, if you asked cardiologists or primary care doctors around the world, we all kind of knew that the rate of hypertension was high, but just the sheer magnitude of what they’re saying in this report suggests that it’s even a bigger problem than most of us thought,” Kulkarni says.
While some of the increase can be ascribed to better detection methods, “the consensus is that this is a real increase,” Kulkarni says. “We are seeing hypertension rates that are higher than they were three decades ago.”
Behind the Numbers
He says there are three main causes to hypertension: An increasingly aging population, a shift in diets to foods higher in salt and fat, and more sedentary lifestyles as more people worldwide switch from an industrial economy to a digital economy.
In the U.S., Kulkarni says, the amount of salt in the average diet has gone way up in recent decades, even in traditionally non-processed foods.
“Chicken breasts now have salt, because it’s used to make the chicken breasts look plumper in the grocery store. So even foods that traditionally we think wouldn’t have salt in it now do,” he says.
Restaurants and carryout meals have even more salt than ever, Kulkarni says, and “our appetite for salt is increasing.” He also finds that obesity, brought on in part by those foods and increasingly inactive lifestyles, plays a major role, as do stress and genetics. There are “some components that we just can’t control.”
The WHO says that hypertension control programs should be high on nations’ list of priorities.
“Hypertension can be controlled effectively with simple, low-cost medication regimens, and yet only about one in five people with hypertension have controlled it,” Dr. Tedros Adhanom Ghebreyesus, the director general of WHO, said in a statement. “Hypertension control programmes remain neglected, under-prioritized and vastly underfunded. Strengthening hypertension control must be part of every country’s journey towards universal health coverage, based on well-functioning, equitable and resilient health systems, built on a foundation of primary health care.”
Kulkarni agrees: “Treating hypertension significantly reduces your risk of having a heart attack or stroke and significantly reduces your risk of kidney disease and kidney failure. There’s so many diseases that fall downstream from my blood pressure.”
New Strategies
New treatments can help out, especially among people whose blood pressure doesn’t respond to regular medications: “The weight loss diabetic medications, like Ozempic — certainly they don’t treat hypertension directly, but because of the way that they handle salt in the way that they reduce your weight, they may have some impact on blood pressure, as well.”
Kulkarni also mentioned the new procedure called renal denervation, in which “we put a catheter into the blood vessel going to your kidneys, and zap the tissue around the blood vessel that contains a nerve that we think drives hypertension.” He says cardiologists “thought for a long time [it] was going to be junk science,” but it turns out that it could be a “really cool space” and that the FDA will likely approve the treatment this year.
All that said, Kulkarni maintains, “The old saws still hold. The classic thing you’ve heard about, probably since we were children, about salt and exercise and low-fat diet and controlling weight — those still work, and they’re as powerful as any medication in terms of reducing blood pressure and reducing risk.”
Feature image, stock.adobe.com
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