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Elevated blood pressure levels are the leading cause of death across the world, causing more than 7 million deaths each year. According to a new research report from The George Institute for International Health, published in the journal Hypertension, blood pressure related diseases such as coronary heart disease and stroke are continuing to cause potentially preventable death and disability globally, with a particularly large burden in developing countries such as India and China.

Blood pressure related diseases are taking a massive social and economic toll on low income countries and crippling already fragile health systems. In 2005 the World Health Organisation recognised blood pressure-related diseases as a major cause of premature death and disability and a serious threat to social and economic development. With massive populations and limited resources, developing countries are struggling to manage the rise in affected patients.

Many lower income countries lack the infrastructure to identify those at risk of blood pressure related diseases. According to author Dr Vlado Perkovic at The George Institute, "Scores of people in these regions are unaware that they have high blood pressure. What’s needed are new approaches to the identification and treatment of individuals at high risk of blood pressure related diseases, utilising low cost but highly effective therapies that are already widely available. Health care providers must be trained and encouraged to provide screening, risk assessment and monitoring. The emphasis then moves to prevention rather than treatment, which is much more cost-effective for most nations."

By 2025, more than 1.5 billion adults across the world are expected to be affected by elevated blood pressure. In high-income regions, the numbers of hypertensive individuals are predicted to grow by 70 million, compared to a rise of 500 million in developing countries. Fortunately, blood pressure lowering drugs have played an important role in reducing the prevalence of blood pressure related diseases in most developed countries. However, this has not been the case in low income countries, and as the prevalence of elevated blood pressure continues to rise, these countries face a huge looming burden of disease.

Potentially preventable cardiovascular diseases place a huge social and economic burden on individuals and the community. For example, stroke places a huge personal and financial burden on the victim, their families and their broader communities. This is particularly true in developing countries in Asia, where stroke rates are very high and commonly affect relatively young individuals in the prime of their working life, yet the risk of stroke can be substantially and effectively lowered by widely available low cost BP lowering therapies.

"While safe and effective antihypertensive treatment could be effectively provided in many developing countries, in the form of a cheap generic blood pressure lowering drug, the reality is that most people who need them are not receiving any treatments at all. Many lower income countries face a double burden of communicable and non-communicable disease, yet allocate limited resources to deal with the rise in these conditions," added Dr Perkovic.

According to the report, diuretics are available, affordable and suitable for resource poor settings. One such drug can be purchased internationally for around 0.3 cents per tablet, which equates to around US$1 per person per year or US$50 million to treat most very high risk individuals in both China and India. Dr Perkovic explains that this should be achievable but the absence of a functional primary health care service in the region means that even free or inexpensive drugs cannot be reliably provided to patients. "Often, for patients, the prices are grossly inflated or financial incentives for health care providers means that more expensive drugs are more often prescribed," he said.

Even a 10mmHg reduction in systolic blood pressure provides up to 25% reduction of cardiovascular events. Previous work at The George Institute has shown that blood pressure lowering benefits a wide population, regardless of region or country. It’s vital that treatment policy targets those most in need both in terms of absolute disease risk and those with severe hypertension. Regionally tailored programs must be developed to counter this rise in hypertension.

Health systems need to focus on provider training, assessing and monitoring patients’ health status and providing a regular reliable treatment supply. "Consumers must have access to cheap or subsidised drugs, health education about blood pressure and cardiovascular diseases, in addition to access to community programs aimed at self-referral for risk assessment. Provider incentives are likely to improve medical record keeping. Governments must regulate drug supply to assure continuity and cost management." added Dr Perkovic.