Report calls for fresh approach to treating hypertension, the world’s top killer

The Lancet Commission on Hypertension has been launched at the 26th Scientific Meeting of the International Society of Hypertension in Seoul, Korea.

This major review sets out a ten point action plan to improve the way hypertension (high blood pressure) is treated on a global scale. The Lancet Commission on Hypertension, launched today September 27, highlights unsolved areas that need to tackled to reduce the burden of hypertension – including how blood pressure is measured and debate over what constitutes safe levels of salt in the diet.

The review says despite hypertension being the world’s number one killer and affecting 30 percent of adults, it is still often unrecognised.

Stuart Spencer, Senior Executive Editor at The Lancet, said: “Hypertension is the main cause of cardiovascular disease and often goes untreated. The report identifies a number of unresolved issues, for instance, how people in the developing world can access drug treatments and screening, and aims to prompt new ways of tackling hypertension, both from an individual and public health perspective.”

Vlado Perkovic, Executive Director of The George Institute, Australia, who was a co-author of the review, welcomed the report: “High blood pressure is unfortunately all too common around the world. We know that it can be prevented through changes to lifestyle such as eating less salt, taking more exercise, weight loss and drinking less alcohol.

“But many people have no idea their blood pressure is high, putting them at much greater risk of stroke, heart attack and kidney disease. This report sets priority areas for action by Governments and healthcare organisations around the world to improve awareness of blood pressure levels, and improve prevention and treatment of high blood pressure, so that we can reduce the harmful effects of this silent killer.”

The Commission calls for more sophisticated methods of individualised treatment based on robust research findings, but also new research to fill knowledge gaps. It claims as a result of increases in population, ageing, urbanisation and obesity, the number of people with hypertension can be expected to increase in low-income and some middle-income countries if not counteracted by concerted action.  It sets out the following ten priority actions it hopes will be adopted by governments worldwide to reduce the global burden of hypertension.

Prevention: lifestyle and environmental changes

Health promoting environment

Creating a healthy environment through strategies that accelerate socioeconomic improvements and implementation of accepted health-promoting policies

Healthy behaviours

Universal understanding of unhealthy and healthy lifestyles and blood pressure through endorsed, early, and sustained education using new technologies

Measurement access

Universal access to measurement of blood pressure through inexpensive blood pressure monitors (linked to establishment of global blood pressure surveillance)

Blood pressure diagnosis and evaluation

Measurement quality

Better quality of blood pressure measurements through endorsed protocols and certified and validated blood pressure monitors


Better identification of people at high risk to optimise treatment approaches through endorsed education of patients and health-care professionals (linked to stratified treatment approaches)

Secondary hypertension

Better identification of people with secondary hypertension through endorsed and simple flow charts (linked to stratified treatment approaches)

Pharmacological prevention and monitoring

Workforce expansion

Expand the workforce engaged in the management of blood pressure through task sharing and the use of endorsed education of community health workers (linked to health-care system accountability)

Medication access

Universal access to affordable, high-quality, and effective antihypertensive drugs through collaboration between all major stakeholders

Standardised treatment

Treatment approaches stratified according to age, cardiovascular risk, social, cultural, and ethnic differences through endorsed education of health-care professionals and initiation of new research

Blood pressure and health-care system

Health-system strengthening

Promote and ensure capacity and accountability of the health system to conduct surveillance and monitoring, and respond appropriately to blood pressure levels


Read the full report in The Lancet.