High blood pressure is an epidemic as devastating as HIV
4 March 2014
The response of most governments and international aid agencies
to high blood pressure, or hypertension, is little better than the
reaction to HIV/AIDS 20 years ago — too little too late — according
to an editorial in the International Journal of Epidemiology.
Hypertension is not an infectious disease, but like HIV it can
lead to fatal and disabling illness. It is estimated that the number
of deaths attributable to the condition globally over the next 20
years may substantially exceed the number resulting from HIV/AIDS.
Yet the researchers — experts in social policy, international
development, public health and HIV — say there is “denial” and
misunderstanding about the impact of hypertension, despite the two
conditions having a number of things in common. Both diseases can
also be treated and managed as chronic conditions through a
combination of drug treatment and lifestyle changes.
In their editorial entitled ‘Is hypertension the new HIV
epidemic?’ they write: “It has been suggested that valuable lessons
for hypertension could be taken from HIV/AIDS policies. Yet there is
little indication that these are being taken on board. Our response
to the global epidemic of hypertension seems little better than our
response to HIV/AIDS two decades ago: too little too late. Can we
not wake up earlier this time, before millions have died?
“HIV is a major global health priority and is recognised as a
serious threat to public health and development in many poorer
countries. Hypertension is seen as a disease of the West, of
prosperity and therefore of little relevance to poorer countries.
This is despite the growing body of evidence that prevalences in
poorer countries are quickly catching up.”
They say the fact
that hypertension is a non-communicable (NCD) disease and the
behavioural factors associated with it, such as obesity, lack of
physical exercise and poor diet, make it difficult to persuade
funders and tax-payers to help people who “eat and smoke too much”.
Where national NCD control programmes have been set up, most remain
a low priority and implementation “creeps along with frustrating
slowness”, a situation they argue is reminiscent of the slow
build-up of AIDS control programmes prior to 1990.
“While hypertension is not an infectious disease, the risky
behaviours associated with it are spreading fast and seem to be as
effectively transmitted as infectious agents.
“HIV was faced with political denial and public misunderstanding
in the early years of the pandemic, especially in some poorer
countries. There is a similar pattern of denial with hypertension …
This denial is based on the misguided view that hypertension does
not affect poorer social groups. Yet there is substantial evidence
that hypertension is highly prevalent among poorer groups and that
they are less likely to have access to effective treatment. As with
HIV, hypertension can be both a cause and a consequence of poverty.
“Recent debate about the extent to which global health policy
priorities should shift from infectious diseases such as HIV to
non-communicable diseases such as hypertension…has mainly pivoted on
a social gradient ‘beauty contest’, disputing the pace at which
conditions such as hypertension affect the poor...Rather than
framing policy as a choice between competing priorities, the key
challenge is to roll out services and interventions which address
Prof Lloyd-Sherlock and Prof Ebrahim are co-authors (with others)
of ‘Hypertension among older adults in low and middle-income
countries: prevalence, awareness and control’, published in the
February issue of the International Journal of Epidemiology.
Lloyd-Sherlock P, Ebrahim S, Grosskurth H. Is hypertension the
new HIV epidemic?
Int. J. Epidemiol.