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Hypertension is still a killer - but there is good news

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Dr Tom Frieden, director of the US CDC from 2009-2017, helped establish the Bloomberg Initiative to Reduce Tobacco Use, which has helped countries take actions that will prevent 40 million deaths. He is president and chief executive of Resolve to Save Lives and a senior fellow for global health at the Council on Foreign Relations

October 06, 2023

Last month, the World Health Organisation released its first-ever report on hypertension, the world’s leading killer.

Please pause for a moment to consider that sentence. World’s leading killer. First report ever.

High blood pressure kills an estimated 10.8 million people every year. That’s more than all people killed by infectious diseases every year. More than killed by the Covid-19 pandemic at its worst. More than lost their lives in any year of war for all of human history, with the possible exception of the peak of the Second World War. It’s one death every three seconds – about 100 by the time you finish reading this essay.

Why, since hypertension is the world’s leading cause of death, did it take until 2023 for there to be a global report on hypertension?

I don’t know for sure, but I suspect three deadly reasons. First, cardiovascular disease – for which hypertension is the leading risk factor – is so common it has become invisible. Second, we assume it’s inevitable. Third, we may believe it’s “only” old people.

Hypertension is a pandemic, and the deadliest of our time. It’s not inevitable: it can be prevented, and, once it develops, treated to prevent heart attack, stroke, kidney failure, and other health problems. Millions of those who die are under age 70, particularly in lower-income countries; for those who die over age 70, uncontrolled hypertension has often caused years of disability and suffering.

A woman has her blood pressure taken at a World Hypertension Day event in Amman, Jordan. Hypertension prevalence is higher in Middle Eastern countries, on average, than anywhere else in the world. Reuters
A woman has her blood pressure taken at a World Hypertension Day event in Amman, Jordan. Hypertension prevalence is higher in Middle Eastern countries, on average, than anywhere else in the world. Reuters

The world’s most deadly condition is also the most neglected. The number of people living with the condition has more than doubled since 1990, to 1.3 billion. Only approximately one in five people with hypertension are adequately treated.

Hypertension prevalence is higher in Middle Eastern countries, on average, than anywhere else in the world. No country in the region has reached the 50 per cent control level that is a global benchmark of effective care.

But there’s good news. The first-ever report not only details the staggering burden of hypertension but also finds that over the next 25 years, improved blood pressure control could avert more than 70 million deaths and approximately 120 million strokes and 80 million heart attacks.

Prevention and effective treatment are possible – but they require societal action and leadership more than individual behaviour change. Improving hypertension control could save more lives than any other adult primary healthcare intervention.

More than 5.5 million people in England may be suffering from high blood pressure (hypertension) without any symptoms. Every health system should track and improve the proportion of the estimated number of all people with high blood pressure who have it under control. Only three countries reach even half: Canada, Costa Rica and South Korea. PA Wire
More than 5.5 million people in England may be suffering from high blood pressure (hypertension) without any symptoms. Every health system should track and improve the proportion of the estimated number of all people with high blood pressure who have it under control. Only three countries reach even half: Canada, Costa Rica and South Korea. PA Wire

The single-most effective way to prevent hypertension is to reduce the amount of sodium in the food everyone eats. Preindustrial societies consumed a small fraction of the sodium that we do currently and didn’t have any age-related increase in blood pressure – an increase we’ve come to view, incorrectly, as an inevitable part of the ageing process. We don’t have to become hunter-gatherers to reduce our sodium consumption, but reducing sodium is extremely difficult for individuals to do because there is so much sodium in our modern diet.

A best-practice policy is to require black stop-sign warnings on unhealthy food. This type of label has been shown to be much more effective than traffic light or other labels; it improves the options, as companies rapidly reformulate food to be healthier, and the choices, as consumers buy healthier food.

A second best-practice approach, promotion of low-sodium salts – which generally contain 15-30 per cent potassium – has been shown to substantially reduce the risk of heart attack and stroke. These salts are safe for everyone other than people with serious kidney disease, who should avoid high-potassium foods such as figs, dates and pomegranates as well as potassium-containing salt.

Treatment of hypertension works. Every health system should track and improve the proportion of the estimated number of all people with high blood pressure who have it under control. Only three countries reach even half: Canada, Costa Rica and South Korea. Every other country can improve a lot, and even those three countries can improve. Countries that improve their hypertension control rate will save lots of lives, because, by far, controlling hypertension can save more adult lives than any other clinical intervention.

Lack of access to medications condemns millions of people to avoidable heart attacks and strokes

The WHO report summarised data from 32 countries that have enrolled 17 million patients into treatment programmes that follow the WHO Hearts guidelines. My organisation, Resolve to Save Lives, partners with WHO and many of the countries implementing these programmes. The bottom line is that the programmes are highly effective through five strategies.

For starters, there is a need for practical, standardised, drug- and dose-specific treatment protocols. Effective protocols provide a straightforward stepwise formula; the best healthcare system in the US, Kaiser-Permanente, uses this type of protocol.

Next, there must be reliable access to affordable hypertension medicines and independently validated blood pressure monitors. Although treatment can cost as little as $5-10 for every patient every year, lack of access to medications condemns millions of people to avoidable heart attacks and strokes.

Just as vital is team‐based care, involving primary healthcare workers accessible to patients to provide care following physician‐directed protocols.

Patient‐centred services are also important, especially medications provided with no out-of-pocket cost and services that reduce barriers to adherence.

Finally, healthcare workers need user-centred information systems that make their jobs less difficult and improve quality of care. These systems will provide real‐time feedback on adherence and blood pressure control of individual patients and facilitate programme assessment and quality improvement initiatives by health systems, health directors, and ministry of health staff.

It costs about 1 cent a pill for the first-line medicines that treat high blood pressure, high cholesterol and high blood sugar. The main three medicines are amlodipine for blood pressure control, atorvastatin for cholesterol and metformin for sugar. All are generic and low-cost. It wouldn’t cost that much to offer these medications free to countries that set up systems to provide effective, accountable care.

For example, the Bangladesh Hypertension Control Initiative has enrolled 200,000 patients and achieved a blood pressure control rate of 60 per cent among treated patients. The programme has the potential to expand to offer treatment to every patient in the country quickly.

As countries in the Middle East, and particularly in the Gulf, gain economic strength and regional and global political influence, they can lead efforts to curb the world’s leading killer by implementing at home and supporting abroad proven means to prevent and treat hypertension.

Despite being the world’s leading single cause of death, less than 1 per cent of global health funding goes to fight cardiovascular disease. By leading at home and investing in philanthropic support abroad, a country can become the world leader against the world’s leading killer, accelerate progress towards the UN Sustainable Development Goals, save millions of lives, and help people live longer, stay healthier, and enjoy more productive lives with less disability.

Exercise helps to lower blood pressure by reducing vessel stiffness so blood can flow around the body more easily. Victor Besa / The National
Exercise helps to lower blood pressure by reducing vessel stiffness so blood can flow around the body more easily. Victor Besa / The National
Cycling is just as beneficial as walking to reduce blood pressure. Victor Besa / The National
Cycling is just as beneficial as walking to reduce blood pressure. Victor Besa / The National
Physical activity such as hiking can lower blood pressure by up to 10 points. Reuters
Physical activity such as hiking can lower blood pressure by up to 10 points. Reuters
In a study, blood pressure readings were even more optimal when participants ambled while working. Getty Images
In a study, blood pressure readings were even more optimal when participants ambled while working. Getty Images
Weight training or lifting can reduce blood pressure once the gym session is over. Reuters
Weight training or lifting can reduce blood pressure once the gym session is over. Reuters
Swimming can be beneficial in controlling blood pressure in adults 60 and older. Getty Images
Swimming can be beneficial in controlling blood pressure in adults 60 and older. Getty Images
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Director: Hasan Hadi

Starring: Baneen Ahmad Nayyef, Waheed Thabet Khreibat, Sajad Mohamad Qasem 

Rating: 4/5

Company Profile

Name: JustClean

Based: Kuwait with offices in other GCC countries

Launch year: 2016

Number of employees: 130

Sector: online laundry service

Funding: $12.9m from Kuwait-based Faith Capital Holding

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Price, base: Dh1,731,672

Engine: 6.5-litre V12

Gearbox: Seven-speed automatic

Power: 770hp @ 8,500rpm

Torque: 720Nm @ 6,750rpm

Fuel economy: 19.6L / 100km

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Citadel: Honey Bunny first episode

Directors: Raj & DK

Stars: Varun Dhawan, Samantha Ruth Prabhu, Kashvi Majmundar, Kay Kay Menon

Rating: 4/5

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Starring: Anthony Mackie, Aiysha Hart, Ben Kingsley

Director: Rupert Wyatt

Rating: 3/5

Ferrari 12Cilindri specs

Engine: naturally aspirated 6.5-liter V12

Power: 819hp

Torque: 678Nm at 7,250rpm

Price: From Dh1,700,000

Available: Now

Emergency phone numbers in the UAE

Estijaba – 8001717 –  number to call to request coronavirus testing

Ministry of Health and Prevention – 80011111

Dubai Health Authority – 800342 – The number to book a free video or voice consultation with a doctor or connect to a local health centre

Emirates airline – 600555555

Etihad Airways – 600555666

Ambulance – 998

Knowledge and Human Development Authority – 8005432 ext. 4 for Covid-19 queries

Mohammed bin Zayed Majlis
Interview
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Power: 325hp

Torque: 500Nm

Transmission: 10-speed automatic

Price: From Dh189,700

On sale: now

STAGE 4 RESULTS

1 Sam Bennett (IRL) Deceuninck-QuickStep - 4:51:51

2 David Dekker (NED) Team Jumbo-Visma

3 Caleb Ewan (AUS) Lotto Soudal 

4 Elia Viviani (ITA) Cofidis

5 Matteo Moschetti (ITA) Trek-Segafredo

General Classification

1 Tadej Pogacar (SLO) UAE Team Emirates - 12:50:21

2 Adam Yates (GBR) Teamn Ineos Grenadiers - 0:00:43

3 Joao Almeida (POR) Deceuninck-QuickStep - 0:01:03

4 Chris Harper (AUS) Jumbo-Visma - 0:01:43

5 Neilson Powless (USA) EF Education-Nippo - 0:01:45

The biog

Favourite Emirati dish: Fish machboos

Favourite spice: Cumin

Family: mother, three sisters, three brothers and a two-year-old daughter

Tomorrow 2021
THE SPECS

Engine: 6.75-litre twin-turbocharged V12 petrol engine 

Power: 420kW

Torque: 780Nm

Transmission: 8-speed automatic

Price: From Dh1,350,000

On sale: Available for preorder now

COMPANY%20PROFILE
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Classification of skills

A worker is categorised as skilled by the MOHRE based on nine levels given in the International Standard Classification of Occupations (ISCO) issued by the International Labour Organisation. 

A skilled worker would be someone at a professional level (levels 1 – 5) which includes managers, professionals, technicians and associate professionals, clerical support workers, and service and sales workers.

The worker must also have an attested educational certificate higher than secondary or an equivalent certification, and earn a monthly salary of at least Dh4,000. 

Sheikh Zayed's poem

When it is unveiled at Abu Dhabi Art, the Standing Tall exhibition will appear as an interplay of poetry and art. The 100 scarves are 100 fragments surrounding five, figurative, female sculptures, and both sculptures and scarves are hand-embroidered by a group of refugee women artisans, who used the Palestinian cross-stitch embroidery art of tatreez. Fragments of Sheikh Zayed’s poem Your Love is Ruling My Heart, written in Arabic as a love poem to his nation, are embroidered onto both the sculptures and the scarves. Here is the English translation.

Your love is ruling over my heart

Your love is ruling over my heart, even a mountain can’t bear all of it

Woe for my heart of such a love, if it befell it and made it its home

You came on me like a gleaming sun, you are the cure for my soul of its sickness

Be lenient on me, oh tender one, and have mercy on who because of you is in ruins

You are like the Ajeed Al-reem [leader of the gazelle herd] for my country, the source of all of its knowledge

You waddle even when you stand still, with feet white like the blooming of the dates of the palm

Oh, who wishes to deprive me of sleep, the night has ended and I still have not seen you

You are the cure for my sickness and my support, you dried my throat up let me go and damp it

Help me, oh children of mine, for in his love my life will pass me by. 

Tributes from the UAE's personal finance community

• Sebastien Aguilar, who heads SimplyFI.org, a non-profit community where people learn to invest Bogleheads’ style

“It is thanks to Jack Bogle’s work that this community exists and thanks to his work that many investors now get the full benefits of long term, buy and hold stock market investing.

Compared to the industry, investing using the common sense approach of a Boglehead saves a lot in costs and guarantees higher returns than the average actively managed fund over the long term. 

From a personal perspective, learning how to invest using Bogle’s approach was a turning point in my life. I quickly realised there was no point chasing returns and paying expensive advisers or platforms. Once money is taken care off, you can work on what truly matters, such as family, relationships or other projects. I owe Jack Bogle for that.”

• Sam Instone, director of financial advisory firm AES International

"Thought to have saved investors over a trillion dollars, Jack Bogle’s ideas truly changed the way the world invests. Shaped by his own personal experiences, his philosophy and basic rules for investors challenged the status quo of a self-interested global industry and eventually prevailed.  Loathed by many big companies and commission-driven salespeople, he has transformed the way well-informed investors and professional advisers make decisions."

• Demos Kyprianou, a board member of SimplyFI.org

"Jack Bogle for me was a rebel, a revolutionary who changed the industry and gave the little guy like me, a chance. He was also a mentor who inspired me to take the leap and take control of my own finances."

• Steve Cronin, founder of DeadSimpleSaving.com

"Obsessed with reducing fees, Jack Bogle structured Vanguard to be owned by its clients – that way the priority would be fee minimisation for clients rather than profit maximisation for the company.

His real gift to us has been the ability to invest in the stock market (buy and hold for the long term) rather than be forced to speculate (try to make profits in the shorter term) or even worse have others speculate on our behalf.

Bogle has given countless investors the ability to get on with their life while growing their wealth in the background as fast as possible. The Financial Independence movement would barely exist without this."

• Zach Holz, who blogs about financial independence at The Happiest Teacher

"Jack Bogle was one of the greatest forces for wealth democratisation the world has ever seen.  He allowed people a way to be free from the parasitical "financial advisers" whose only real concern are the fat fees they get from selling you over-complicated "products" that have caused millions of people all around the world real harm.”

• Tuan Phan, a board member of SimplyFI.org

"In an industry that’s synonymous with greed, Jack Bogle was a lone wolf, swimming against the tide. When others were incentivised to enrich themselves, he stood by the ‘fiduciary’ standard – something that is badly needed in the financial industry of the UAE."

Points Classification

1. Marcel Kittel (Germany / Quick-Step) 63

2. Arnaud Demare (France / FDJ) 38

3. Andre Greipel (Germany / Lotto) 25

4. Sonny Colbrelli (Italy / Bahrain) 24

5. Mark Cavendish (Britain / Dimension Data) 22

6. Taylor Phinney (U.S. / Cannondale) 21

7. Geraint Thomas (Britain / Team Sky) 20

8. Thomas Boudat (France / Direct Energie) 20

9. Stefan Kueng (Switzerland / BMC Racing) 17

10. Michael Matthews (Australia / Sunweb) 17

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Publisher: Konami

Platforms: PlayStation 5, Xbox Series X/S, PC

Rating: 4.5/5

THE BIO

Born: Mukalla, Yemen, 1979

Education: UAE University, Al Ain

Family: Married with two daughters: Asayel, 7, and Sara, 6

Favourite piece of music: Horse Dance by Naseer Shamma

Favourite book: Science and geology

Favourite place to travel to: Washington DC

Best advice you’ve ever been given: If you have a dream, you have to believe it, then you will see it.

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Five out of five stars 

What is blockchain?

Blockchain is a form of distributed ledger technology, a digital system in which data is recorded across multiple places at the same time. Unlike traditional databases, DLTs have no central administrator or centralised data storage. They are transparent because the data is visible and, because they are automatically replicated and impossible to be tampered with, they are secure.

The main difference between blockchain and other forms of DLT is the way data is stored as ‘blocks’ – new transactions are added to the existing ‘chain’ of past transactions, hence the name ‘blockchain’. It is impossible to delete or modify information on the chain due to the replication of blocks across various locations.

Blockchain is mostly associated with cryptocurrency Bitcoin. Due to the inability to tamper with transactions, advocates say this makes the currency more secure and safer than traditional systems. It is maintained by a network of people referred to as ‘miners’, who receive rewards for solving complex mathematical equations that enable transactions to go through.

However, one of the major problems that has come to light has been the presence of illicit material buried in the Bitcoin blockchain, linking it to the dark web.

Other blockchain platforms can offer things like smart contracts, which are automatically implemented when specific conditions from all interested parties are reached, cutting the time involved and the risk of mistakes. Another use could be storing medical records, as patients can be confident their information cannot be changed. The technology can also be used in supply chains, voting and has the potential to used for storing property records.

Reputation

Taylor Swift

(Big Machine Records)

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Updated: October 06, 2023, 7:26 PM
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