High Blood Pressure Is Now The Problem Of The World’s Poor

As high blood pressure has exploded worldwide, wealthier countries are actually getting healthier

Photo Illustration: Vocativ
Nov 17, 2016 at 9:00 AM ET

The number of people with high blood pressure has doubled in the last 40 years, with 1.13 billion people now living with the condition. But the increase hasn’t been felt equally, according to a new study. High blood pressure was once a problem for the world’s wealthiest nations, but now it disproportionately affects the world’s poorest.

High blood pressure is the leading cause of cardiovascular disease and increases the risk of heart attack or stroke. While some of the increase in the number of people with high blood pressure is tied to general population growth, the percentage of the population with higher blood pressure has also risen since 1975. Researchers at Imperial College London have put together a massively comprehensive look at how blood pressure has changed in every country on the planet, looking at measurements from more than 20 million people to build a picture of blood pressure worldwide.

“This is the most comprehensive global analysis of blood pressure and the only one to span four decades and various outcomes,” lead researcher Majid Ezzati told Vocativ in an email. “It provides the strongest evidence that taken globally, high blood pressure has shifted from a condition affecting wealthier countries to one that is much higher in poorest countries, due to opposite trends in the two groups.”

About half of the 1.13 billion people live in Asia, with India and China each home to about 200 million people with high blood pressure. Surprisingly, given America’s love of fast food, United States actually has the second lowest rates of high blood pressure in the world for both men and women, behind only South Korea. Joining them in the top five are Canada, Peru, and Singapore.

High blood pressure tends to affect men more severely than women, with 597 million men affected compared with 521 million women. What’s more, the countries with the highest rates of raised blood pressure are very different for men and women. For men, Central and Easter European countries like Croatia, Latvia, Lithuania, Hungary, and Slovenia have the highest rates, whereas the Sub-Saharan African countries Niger, Chad, Mali, Burkina Faso, and Somalia have the highest rates for women.

To better understand how rates of high blood pressure have changed over the last 40 years, we can look at how blood pressure has changed in the 10 richest and 10 poorest countries. Forty years ago, 39.8 percent of men and 33.8 percent of women in the 10 wealthiest countries had high blood pressure, which has been roughly halved to 22.3 percent and 15.6 percent today. The 10 richest countries represent a diverse cross section of oil-rich nations, western democracies, and Singapore, whereas the 10 poorest countries are all in Sub-Saharan Africa. In those countries, the increase hasn’t been as big, but it’s still there: The percentage of men with high blood pressure has risen from 26.7 percent to 28.5 percent, compared with 24.8 percent to 30.2 percent for women.

So what’s driving those divergent trends? Ezzati said people in wealthier countries get their blood pressure measured more frequently, meaning problems are caught sooner, and they have better access to medication than those in poorer countries.

“High-income countries are becoming better at incorporating blood pressure measurement and, when needed, treatment in primary care system, although more needs to be done,” he said. “A lot less is being done in low/middle-income countries.”

It’s not just a question of better medical care, though. People in wealthier nations are typically eating more healthily than they were 40 years ago, if not in terms of quantity of food eaten – obesity is still very much an epidemic – then at least in terms of the kinds of high-sodium foods that are linked with high blood pressure. Ezzati points out that richer nations are more likely to have fresh, affordable produce available year-round and implement regulation or education policies about the dangers of salt.

High blood pressure is more than just an individual medical issue. Its link with heart and kidney disease and early death can have added economic consequences for people and societies already living in poverty. In less wealthy countries, blood pressure tends to affect people at younger ages, translating to extra years or even decades of reduced ability to live and work.

The World Health Organization has set a goal of reducing by 25 percent the number of people with high blood pressure by 2025. If we take this study’s figure, that means reducing the blood pressure of 300 million people in the next decade. It’s a tall order, and if this study is any indication, those who have the least are the ones who need the most help.