Blood pressure control: a challenge to global health systems

Raised blood pressure is the most important risk factor in the global burden of disease.1 Although there is robust evidence to show that lowering blood pressure can substantially reduce cardiovascular morbidity and mortality,2 the global burden of hypertension is increasing.3,4 To achieve a reduction in the burden of disease related to hypertension, health systems must ensure that high blood pressure treatment and control rates are achieved. The factors involved range from social determinants (such as rapid and unplanned urbanisation, poverty, illiteracy, the political context, gender and racial discrimination, the human development index, and social development); to factors relating to health care (infrastructure, availability, access, and quality), medical education (the number of physicians, nurses, and paramedical workers), and physicians (competing interests, information overload, and inertia); to patient adherence. In HICs, availability and affordability of medication are less likely to be a barrier to effective control of blood pressure, but better strategies to address physician inertia or medical patient adherence might be needed.