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.
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.
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.
THE APPRENTICE
Director: Ali Abbasi
Starring: Sebastian Stan, Maria Bakalova, Jeremy Strong
Rating: 3/5
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Spain drain
CONVICTED
Lionel Messi Found guilty in 2016 of of using companies in Belize, Britain, Switzerland and Uruguay to avoid paying €4.1m in taxes on income earned from image rights. Sentenced to 21 months in jail and fined more than €2m. But prison sentence has since been replaced by another fine of €252,000.
Javier Mascherano Accepted one-year suspended sentence in January 2016 for tax fraud after found guilty of failing to pay €1.5m in taxes for 2011 and 2012. Unlike Messi he avoided trial by admitting to tax evasion.
Angel di Maria Argentina and Paris Saint-Germain star Angel di Maria was fined and given a 16-month prison sentence for tax fraud during his time at Real Madrid. But he is unlikely to go to prison as is normal in Spain for first offences for non-violent crimes carrying sentence of less than two years.
SUSPECTED
Cristiano Ronaldo Real Madrid's star striker, accused of evading €14.7m in taxes, appears in court on Monday. Portuguese star faces four charges of fraud through offshore companies.
Jose Mourinho Manchester United manager accused of evading €3.3m in tax in 2011 and 2012, during time in charge at Real Madrid. But Gestifute, which represents him, says he has already settled matter with Spanish tax authorities.
Samuel Eto'o In November 2016, Spanish prosecutors sought jail sentence of 10 years and fines totalling €18m for Cameroonian, accused of failing to pay €3.9m in taxes during time at Barcelona from 2004 to 2009.
Radamel Falcao Colombian striker Falcao suspected of failing to correctly declare €7.4m of income earned from image rights between 2012 and 2013 while at Atletico Madrid. He has since paid €8.2m to Spanish tax authorities, a sum that includes interest on the original amount.
Jorge Mendes Portuguese super-agent put under official investigation last month by Spanish court investigating alleged tax evasion by Falcao, a client of his. He defended himself, telling closed-door hearing he "never" advised players in tax matters.
Hot%20Seat
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Living in...
This article is part of a guide on where to live in the UAE. Our reporters will profile some of the country’s most desirable districts, provide an estimate of rental prices and introduce you to some of the residents who call each area home.
A Long Way Home by Peter Carey
Faber & Faber
Our legal consultant
Name: Dr Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
The biog
Name: Sarah Al Senaani
Age: 35
Martial status: Married with three children - aged 8, 6 and 2
Education: Masters of arts in cultural communication and tourism
Favourite movie: Captain Corelli’s Mandolin
Favourite hobbies: Art and horseback ridding
Occupation: Communication specialist at a government agency and the owner of Atelier
Favourite cuisine: Definitely Emirati - harees is my favourite dish
Company%20Profile
%3Cp%3E%3Cstrong%3ECompany%20name%3A%20%3C%2Fstrong%3ENamara%0D%3Cbr%3E%3Cstrong%3EStarted%3A%20%3C%2Fstrong%3EJune%202022%0D%3Cbr%3E%3Cstrong%3EFounder%3A%20%3C%2Fstrong%3EMohammed%20Alnamara%0D%3Cbr%3E%3Cstrong%3EBased%3A%20%3C%2Fstrong%3EDubai%20%0D%3Cbr%3E%3Cstrong%3ESector%3A%20%3C%2Fstrong%3EMicrofinance%0D%3Cbr%3E%3Cstrong%3ECurrent%20number%20of%20staff%3A%20%3C%2Fstrong%3E16%0D%3Cbr%3E%3Cstrong%3EInvestment%20stage%3A%20%3C%2Fstrong%3ESeries%20A%0D%3Cbr%3E%3Cstrong%3EInvestors%3A%20%3C%2Fstrong%3EFamily%20offices%0D%3Cbr%3E%3C%2Fp%3E%0A
Story%20behind%20the%20UAE%20flag
%3Cp%3EThe%20UAE%20flag%20was%20first%20unveiled%20on%20December%202%2C%201971%2C%20the%20day%20the%20UAE%20was%20formed.%C2%A0%3C%2Fp%3E%0A%3Cp%3EIt%20was%20designed%20by%20Abdullah%20Mohammed%20Al%20Maainah%2C%2019%2C%20an%20Emirati%20from%20Abu%20Dhabi.%C2%A0%3C%2Fp%3E%0A%3Cp%3EMr%20Al%20Maainah%20said%20in%20an%20interview%20with%20%3Cem%3EThe%20National%3C%2Fem%3E%20in%202011%20he%20chose%20the%20colours%20for%20local%20reasons.%C2%A0%3C%2Fp%3E%0A%3Cp%3EThe%20black%20represents%20the%20oil%20riches%20that%20transformed%20the%20UAE%2C%20green%20stands%20for%20fertility%20and%20the%20red%20and%20white%20colours%20were%20drawn%20from%20those%20found%20in%20existing%20emirate%20flags.%3C%2Fp%3E%0A
The biog:
Languages: Arabic, Farsi, Hindi, basic Russian
Favourite food: Pizza
Best food on the road: rice
Favourite colour: silver
Favourite bike: Gold Wing, Honda
Favourite biking destination: Canada
Scores
New Zealand 266 for 9 in 50 overs
Pakistan 219 all out in 47.2 overs
New Zealand win by 47 runs
Benefits of first-time home buyers' scheme
- Priority access to new homes from participating developers
- Discounts on sales price of off-plan units
- Flexible payment plans from developers
- Mortgages with better interest rates, faster approval times and reduced fees
- DLD registration fee can be paid through banks or credit cards at zero interest rates
Zayed Sustainability Prize
The specs: 2018 Ford Mustang GT
Price, base / as tested: Dh204,750 / Dh241,500
Engine: 5.0-litre V8
Gearbox: 10-speed automatic
Power: 460hp @ 7,000rpm
Torque: 569Nm @ 4,600rpm
Fuel economy, combined: 10.3L / 100km
RESULTS
%3Cp%3E%0D%3Cstrong%3E6pm%3A%3C%2Fstrong%3E%20Marfa%20Deira%20%E2%80%93%20Conditions%20(PA)%20Dh80%2C000%20(Dirt)%201%2C200m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%3C%2Fstrong%3E%20Wadheha%2C%20Bernardo%20Pinheiro%20(jockey)%2C%20Majed%20Al%20Jahouri%20(trainer)%0D%3Cbr%3E%3Cstrong%3E6.35pm%3A%20%3C%2Fstrong%3EDubai%20Creek%20%E2%80%93%20Maiden%20(TB)%20Dh82%2C500%20(D)%201%2C400m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%20%3C%2Fstrong%3EBarq%20Al%20Emarat%2C%20Bernardo%20Pinheiro%2C%20Ismail%20Mohammed%0D%3Cbr%3E%3Cstrong%3E7.10pm%3A%20%3C%2Fstrong%3EMina%20Hamriya%20%E2%80%93%20Handicap%20(TB)%20Dh95%2C000%20(D)%201%2C600m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%3C%2Fstrong%3E%20Tahdeed%2C%20Dane%20O%E2%80%99Neill%2C%20Michael%20Costa%0D%3Cbr%3E%3Cstrong%3E7.45pm%3A%3C%2Fstrong%3E%20Mina%20Rashid%20%E2%80%93%20Maiden%20(TB)%20Dh82%2C500%20(D)%201%2C900m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%20%3C%2Fstrong%3ESeyaasi%2C%20Xavier%20Ziani%2C%20Salem%20bin%20Ghadayer%0D%3Cbr%3E%3Cstrong%3E8.20pm%3A%20%3C%2Fstrong%3EAl%20Garhoud%20Sprint%20DP%20World%20%E2%80%93%20Listed%20(TB)%20Dh132%2C500%20(D)%201%2C200m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%3C%2Fstrong%3E%20Mouheeb%2C%20Ray%20Dawson%2C%20Michael%20Costa%0D%3Cbr%3E%3Cstrong%3E8.55pm%3A%3C%2Fstrong%3E%20Mirdiff%20Stakes%20Jebel%20Ali%20Port%20%E2%80%93%20Conditions%20(TB)%20Dh120%2C000%20(D)%201%2C400m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%3C%2Fstrong%3E%20Seyouff%2C%20Antonio%20Fresu%2C%20Michael%20Costa%0D%3Cbr%3E%3Cstrong%3E9.30pm%3A%3C%2Fstrong%3E%20Jebel%20Ali%20Free%20Zone%20%E2%80%93%20Handicap%20(TB)%20Dh95%2C000%20(D)%202%2C000m%0D%3Cbr%3E%3Cstrong%3EWinner%3A%20%3C%2Fstrong%3EAjuste%20Fiscal%2C%20Jose%20da%20Silva%2C%20Julio%20Olascoaga%3C%2Fp%3E%0A
Confirmed%20bouts%20(more%20to%20be%20added)
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GAC GS8 Specs
Engine: 2.0-litre 4cyl turbo
Power: 248hp at 5,200rpm
Torque: 400Nm at 1,750-4,000rpm
Transmission: 8-speed auto
Fuel consumption: 9.1L/100km
On sale: Now
Price: From Dh149,900
BUNDESLIGA FIXTURES
Saturday, May 16 (kick-offs UAE time)
Borussia Dortmund v Schalke (4.30pm)
RB Leipzig v Freiburg (4.30pm)
Hoffenheim v Hertha Berlin (4.30pm)
Fortuna Dusseldorf v Paderborn (4.30pm)
Augsburg v Wolfsburg (4.30pm)
Eintracht Frankfurt v Borussia Monchengladbach (7.30pm)
Sunday, May 17
Cologne v Mainz (4.30pm),
Union Berlin v Bayern Munich (7pm)
Monday, May 18
Werder Bremen v Bayer Leverkusen (9.30pm)
COMPANY PROFILE
Name: HyperSpace
Started: 2020
Founders: Alexander Heller, Rama Allen and Desi Gonzalez
Based: Dubai, UAE
Sector: Entertainment
Number of staff: 210
Investment raised: $75 million from investors including Galaxy Interactive, Riyadh Season, Sega Ventures and Apis Venture Partners
