Intended for healthcare professionals


Hypertension: 76 million deaths could be averted by 2050 if treatment coverage improves, says WHO

BMJ 2023; 382 doi: (Published 20 September 2023) Cite this as: BMJ 2023;382:p2154
  1. Elisabeth Mahase
  1. The BMJ

Around four in five people with hypertension are not adequately treated, the World Health Organization has warned in its first report on the “devastating” global impact of high blood pressure.1

However, it said that countries could still “win the race against this silent killer” and could avert 76 million deaths by 2050 if they “scale up” treatment coverage so that even just half of the people with hypertension have it under control.

This could also prevent 120 million strokes, 79 million heart attacks, and 17 million cases of heart failure, WHO estimated.

“Hypertension control programmes remain neglected, under-prioritised, and vastly underfunded,” said WHO’s director general, Tedros Adhanom Ghebreyesus. “Strengthening hypertension control must be part of every country’s journey towards universal health coverage, based on well functioning, equitable, and resilient health systems, built on a foundation of primary healthcare.”

From 1990 to 2019 the number of people with hypertension worldwide doubled from 650 million to 1.3 billion. It now affects one in three adults, and more than three quarters of those affected live in low and middle income countries.

WHO has recommended five actions that countries should take to improve hypertension control in their populations:

  • Implement practical dose specific and drug specific treatment protocols with specific steps for managing uncontrolled blood pressure;

  • Provide regular, uninterrupted access to affordable medicines;

  • Provide team based care to adjust medicines when needed;

  • Reduce barriers to care by providing easy regimens, free medicines, close-to-home follow-up visits, and readily available blood pressure monitoring; and

  • Put user centred, simple information systems in place to record essential, patient level data and to reduce the data entry burden on staff.

WHO said that the economic benefits of improved hypertension treatment programmes outweighed the costs by about 18:1.

Michael Bloomberg, WHO global ambassador for non-communicable diseases and injuries, said, “Most heart attacks and strokes in the world today can be prevented with affordable, safe, accessible medicines and other interventions, such as sodium reduction. Treating hypertension through primary healthcare will save lives, while also saving billions of dollars a year.”

Salt reduction

The report comes as research published in the Journal of Hypertension found that progress made by the UK’s salt reduction programme had stalled since 2014 after responsibility was handed over to the food industry.2

The authors said that the lack of progress “indicates that the effectiveness of the programme has been compromised.” If the previous successful programme had continued, a further reduction of 1.45 g/day in salt intake would have been expected from 2014 to 2018—potentially preventing more than 38 000 deaths from strokes and heart disease, of which 24 000 would have been premature.3

Sonia Pombo, study coauthor and campaign lead for Action on Salt, said, “The UK’s downfall was trusting the food industry to deliver reductions in salt content without an incentive to do so or enforcement from the government. Urgent resuscitation in the programme is needed if we are to get back on track and save the most lives.”


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