Definition of hypertension

Hypertension, also known as high, raised, or elevated blood pressure (BP), is a medical condition in which the pressure of blood against the walls of arteries is persistently elevated (WHO 2019). Hypertension is defined as the systolic blood pressure being consistently over 140 mmHg and/or the diastolic blood pressure being consistently over 90 mmHg on repeated measurements.

Optimal blood pressure is defined to be less than 120/80 mmHg, normal blood pressure 120-129/80-84 mmHg and high-normal blood pressure 130-139/85-89 mmHg (ESC/ESH 2018). Hypertension rarely has noticeable symptoms and it can only be verified by having blood pressure measured (WHO 2019), (ISH 2020) . Hypertension is a major risk factor for several noncommunicable diseases (NCDs), including cardiovascular diseases and chronic kidney disease (GBD 2020).

Prevalence of hypertension in the EU

The prevalence of measured hypertension varies across the EU Member States but is consistently higher amongst men compared to women (WHO Data Platform). Table 1 presents the age-standardized estimates of measured blood pressure of people aged 18 and older in the EU Member States.

Hypertension becomes more common in older age (ESC/ESH 2018); 3.5% of the younger population (25-34 years) and 53.3% of the older population (>75 years) self-reported hypertension in European Health interview Survey (Eurostat Data Browser). For studies including only older people, the prevalence of hypertension has been significantly higher in EU Member states compared to the ones presented in table 1 (NCD-RisC 2019).

Table 1: Age-standardised prevalence of hypertension (SBP≥140 or DBP ≥90) in adults in EU countries in 2015 based on measured blood pressure

Factors related to hypertension prevention

Hypertension can be attributed to multiple non-modifiable and modifiable risk factors. Non-modifiable risk factors include older age, family history of hypertension, and co-existing diseases such as diabetes or chronic kidney disease. Diet-related risks, physical inactivity, consumption of alcohol and tobacco, and being overweight are considered modifiable and largely preventable risk factors (WHO 2019), (ISH 2020). Table 2 presents the modifiable risk factors that increase or decrease the risk of raising blood pressure and developing hypertension.

Table 2: Modifiable risk factors of hypertension and blood pressure as described by international and national health organisations 

Disease and economic burden related to hypertension

In 2019, the Global Burden of Disease (GBD) study estimated that high systolic blood pressure was globally the leading risk factor for attributable deaths, accounting for 10.8 million deaths (19.2% of all deaths)(GBD 2020). In the EU, high systolic blood pressure accounted for 1.0 million deaths and 15.6 million Disability Adjusted Life Years (DALYs), mainly associated with cardiovascular diseases and chronic kidney disease (GBD 2019). 

The most frequent hypertension-related deaths are due to ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke (ESC/ESH 2018). More than 50% of DALYs caused by ischemic heart disease (55%), stroke (56%), and chronic kidney disease (52%) were attributable to high systolic blood pressure (IHME 2019).

The total yearly cost of cardiovascular diseases in the EU has been estimated at €210 billion (EHN 2017). The direct cost over 10 years associated with hypertension was estimated to be €51.3 billion for five European countries alone (France, Germany, Italy, Spain, England). Hypertension is one of the three chronic diseases with the highest avoidable costs due to poor adherence to prescribed medication. Increasing adherence to 70% has been estimated to save €332 million in the above-mentioned countries (OECD 2018),(Mennini et al.).

View visualisation: DALYs map and data table 

View visualisation: Mortality map and data table 

Policies related to the prevention of hypertension

Reducing the prevalence of hypertension was one of the prevention targets in the WHO Global Action Plan for the prevention and control of noncommunicable diseases for 2013-2020 (WHO 2013, Global action plan). Since 1975, the prevalence of hypertension has decreased in high-income countries, and awareness and treatment of hypertension have improved (NCD-RisC 2017), (NCD-RisC 2019). Hypertension prevention is often part of broader policies or action plans addressing NCDs or, specifically, cardiovascular diseases (WHO 2018 (pdf)), (WHO 2013, Global action plan), (OECD 2015).

These plans emphasize early detection and management of hypertension, and actions on behavioural risk factors: promoting a healthy diet and physical activity, tobacco control, and reducing the harmful use of alcohol (WHO 2018 (pdf)), (WHO 2013, Global action plan), (WHO 2013 Europe (pdf)). WHO has also published a handbook on how to use mobile technology to supplement existing national hypertension control programmes, focusing on above mentioned behavioural risks and a successful implementation (WHO 2020 (pdf)).

Each intervention has different approximate lowering effects on systolic blood pressure, e.g. -5 mmHg for each 1-kg reduction in body weight, -5/6 mmHg for dietary sodium restriction, and -4 mmHg for moderation in alcohol intake in hypertensives (ACC/AHA 2017). Robust evidence indicates that lowering blood pressure significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Every 10 mmHg reduction in systolic blood pressure significantly reduces the relative risk for major cardiovascular disease events (-20%), coronary heart disease (-17%), stroke (-27%), heart failure (-28%), and all-cause mortality (-13%)(Ettehad et al.).

Summaries of policy recommendations addressing factors related to hypertension are listed in other chapters of the Health Promotion and Disease Prevention Knowledge Gateway. These factors include consumption of salt, fats, fibre, fruit and vegetables, sugar and sweeteners, whole grain and alcoholic beverages, as well as physical activity and sedentary behaviour. There are also some examples of best practices in hypertension and associated health promotion interventions in the Public Health Best Practice portal of the European Commission. Some European examples are gathered in WHO’s report on country experiences and effective interventions (WHO 2013 Europe (pdf)).

References

Overview of the references to this brief