JOHTN
EDITORIAL COMMENTARY
World Hypertension League: Its Scope, Purpose, and Impact in South Asia
1Daniel T Lackland, 2C Venkata S Ram 1President, 2Director 1Department of Neurology, World Hypertension League, MedicalUniversity of South Carolina, Charleston, South Carolina, USA 2World Hypertension League, South Asia Region, Apollo Institutefor Blood Pressure Management, Apollo Blood Pressure ClinicsApollo Hospitals, Hyderabad, Telangana, India Texas Blood Pressure Institute, Dallas Nephrology AssociatesUniversity of Texas Southwestern Medical School, DallasTexas, USA Correspondence: Daniel T Lackland, PresidentDepartment of Neurology, World Hypertension League, MedicalUniversity of South Carolina, Charleston, South California, USA Phone: +8438761141 e-mail: lackland@musc.edu
ABSTRACT High blood pressure and hypertension have long beenrecognized as major global risk factors for cardiovasculardisease, stroke, heart failure, end-stage renal disease,peripheral vascular disease, and cerebrovascular disease,with significant impact on more than a billion peopleworldwide.1 With consideration of the population healthindicator of disability-adjusted life years (DALYs), highblood pressure is now considered as the number one riskfactor in the world, including countries, such as India andthe South Pacific region.2,3 How to cite this article: Lackland DT, Ram CVS. WorldHypertension League: Its Scope, Purpose, and Impact in SouthAsia. Hypertens J 2016;2(2):55-56. Source of support: Nil Conflict of interest: None
INTRODUCTION High blood pressure and hypertension have long beenrecognized as major global risk factors for cardiovasculardisease, stroke, heart failure, end-stage renal disease,peripheral vascular disease, and cerebrovascular disease,with significant impact on more than a billion peopleworldwide.1 With consideration of the population healthindicator of disability-adjusted life years (DALYs), highblood pressure is now considered as the number one riskfactor in the world, including countries, such as India andthe South Pacific region.2,3Hypertension-related conditions, such as stroke,end-stage renal disease, and heart failure could havebeen prevented or delayed with treated and controlledhigh blood pressure, regardless of demographics.4 Thus,hypertension should be considered the most importantpreventable cause of premature death worldwide. Structured prevention and management programswere based on the population premise, i.e., if theelevation of blood pressure with age can be preventedor reduced, hypertension-related outcomes, such asstroke, heart failure, and end-stage renal diseases canbe significantly reduced. In addition to clinical treatmentand control of elevated blood pressure, theseprograms incorporate risk factor reduction including excess body weight; excess dietary sodium intake;reduced physical activity; inadequate intake of fruits,vegetables, and potassium; and excess alcohol intake.5Over 20 years earlier, it was estimated that a 5 mm Hgreduction of systolic blood pressure would result in a14% overall reduction in mortality due to stroke.6 Thiswas confirmed by a report demonstrating a significantreduction in the population distributions of systolicblood pressure consistent with the significant reductionin stroke mortality.4 These blood pressure and associatedrisk factors' reductions have been attributed to the publichealth and clinical successes.4   Cardiovascular diseases are responsible for significantmorbidity and mortality in South Asia (Tables 1 and 2). The World Hypertension League (WHL), which isin official relations with the World Health Organization(WHO), was established to focus on the global risks ofhypertension and strategies and programs for populationwith high blood pressure control and prevention. The WHLis the only nongovernmental organization (NGO) at WHOwith a mission strictly devoted to hypertension prevention,management, and control in the population. The inclusionof WHL and the South Pacific Regional Office among theprofessional NGOs at WHO is particularly helpful in stabilizingand facilitating ongoing projects, which includehypertension detection and surveillance, the productionof hypertension awareness material for the public duringWorld Hypertension Day, the development of combinedsessions and symposia at international conferences, andinvolvement of WHO campaigns on salt reduction in globaldiets to prevent hypertension.7-12 The World Health Assembly, a WHO body, called for aglobal action to prevent noncommunicable diseases (NCDs) and to reduce premature mortality (from NCDs) by25% by 2015. The action plan calls for close monitoring,detection, and aggressive control of risk factors forcardiovascular disease. However, this ambitious goalis not possible without a "national" policy for countrieslike India. The entire South Asia is under the grip ofescalating CVD. It is extremely critical for governmentalorganizations and NGOs to work together to achievethe 2025 CVD reduction targets. The WHL is committedto assist and guide the South Asia region to combatthe CVD burden by promoting lifestyle changes andmethodologies to control hypertension. Table 1: Health factors - South Asia Adapted from Global Heart 2014;9:65-70 Table 2: Number of DALYs - South Asia
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Hypertension is the leading cause for NCDs inIndia and nearly 10% of all deaths in the country areattributable to hypertension.13 In less than a decade, thenumber of people with hypertension will increase to214 million.14 Against this background, there is a hugegap between what is known about high blood pressurein India and what is being done to control it. The WHLcalls for immediate action-based objectives for bloodpressure control in India by increasing the awareness ofthis "silent" killer and by advocating massive screening,early diagnosis, and widespread therapeutic implicationsacross India. This intent of WHL can be realized onlythrough the efforts of Indian Society of Hypertension andother like-minded professional organizations. A major objective of the WHL is professional educationfor the health care workforce team, including physicians,nurses, pharmacists, physician assistants, and communityhealth care workers with access to the current evidenceand resources for population hypertension detection,prevention, and control. The efforts of the WHL and theSouth Asia Regional Office have shown significant impactwith great expectations for future risk reductions fromelevated blood pressure throughout the world. REFERENCES Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK,He J. Global burden of hypertension: analysis of worldwidedata. Lancet 2005 Jan 15-21;365(9455):217-223. Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ,Cowan MJ, Farzadfar F, Stevens GA, Lim SS, Riley LM, et al.National, regional, and global trends in systolic blood pressuresince 1980: systematic analysis of health examination surveysand epidemiological studies with 786 country-years and5.4 million participants. Lancet 2011 Feb 12;377(9765):568-577. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD,Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S,et al. Disability-adjusted life years (DALYs) for 291 diseasesand injuries in 21 regions, 1990-2010: a systematic analysisfor the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013;381:628]. Lancet 2012Dec;380(9559):2197-2223. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG,Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD,et al. Factors influencing the decline in stroke mortality: astatement from the American Heart Association/AmericanStroke Association. Stroke 2014 Jan;45(1):315-353.   Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA,Roccella EJ, Stout R, Vallbona C, Winston MC, et al. Primaryprevention of hypertension: clinical and public healthadvisory from the national high blood pressure educationprogram. JAMA 2002 Oct 16;288(15):1882-1888. Stamler R. Implications of the intersalt study. Hypertension1991 Jan;17(Suppl 1):16-20. Campbell NR, Lackland DT, Lisheng L, Zhang XH, Nilsson PM,Niebylski ML. The World Hypertension League Executive.The World Hypertension League: where now and where toin salt reduction. Cardiovasc Diagn Ther 2015 Jun;5(3):238-242. Campbell NRC, Lackland DT, Lisheng L, Zhang XH,Nilsson PM, Redburn KA, Niebylski ML. The World HypertensionLeague challenges hypertension and cardiovascularorganizations to develop strategic plans for the preventionand control of hypertension. J Clin Hypertens 2015May;17(5):325-327. Campbell NRC, Lackland DT, Niebylski ML. 2014 dietary saltfact sheet of the World Hypertension League, InternationalSociety of Hypertension, Pan American Health OrganizationTechnical Advisory Group on Cardiovascular DiseasePrevention Through Dietary Salt Reduction, the WorldHealth Organization Collaborating Centre on PopulationSalt Reduction, and World Action on Salt & Health. J ClinHypertens 2015 Jan;17(1):7-9. Campbell NR, Berbari AE, Cloutier L, Gelfer M, Kenerson JG,Khalsa TK, Lackland DT, Lemogoum D, Mangat BK, Mohan S,et al. Policy statement of the world hypertension league onnoninvasive blood pressure measurement devices and bloodpressure measurement in the clinical or community setting.J Clin Hypertens 2014 May;16(5):320-322. Khalsa TK, Campbell NR, Lackland DT, Lisheng L, Niebylski ML,Zhang XH. Needs assessment of national hypertensionorganizations for hypertension prevention and controlprograms. J Clin Hypertens 2014 Dec;16(12):848-855. Campbell N, Lackland D, Chockalingam A, Lisheng L,Schiffrin EL, Harrap S, Touyz RM, Burrell L, Ramirez A,Schmieder R, et al. The World Hypertension League andInternational Society of Hypertension call on governments,nongovernmental organizations, and the food industryto work to reduce dietary sodium. J Clin Hypertens 2014Feb;16(2):99-100. Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G,Mathers C, Mohan V, Prabhakaran D, Ravindran RD,Reddy KS. Chronic diseases and injuries in India. Lancet2011;377(9763):413-428. Reddy KS, Shah B, Varghese C, Ramadoss A. Respondingto the threat of chronic diseases in India. Lancet 2005 Nov12;366(9498):1744-1749.
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