Richard Smith: Reducing the world’s blood pressure

Richard Smith What do you think is the risk factor that causes the most deaths globally? Until I saw the data I’d have answered tobacco. But in fact it’s high blood pressure. As the figure (see below) shows, tobacco causes about six million deaths a year but high blood pressure around eight million. That’s why the Global Alliance for Chronic Diseases chose hypertension as its first target and yesterday announced its first awards for research in low and middle income countries.

Research funding bodies have to look to the future, said Francis Collins, director of the National Institutes of Health, at the launch of the awards at University College yesterday, and deaths from infection are expected to decline in the next 20 years while deaths from non-communicable disease (NCD) will increase dramatically, potentially more than wiping out all the gains from reducing deaths from infectious disease and maternal and child health problems. As well as causing much pain, suffering, and disability, the cost of managing patients with NCD and lost productivity –put at $47 trillion (75% of current global GDP) over the next 20 years by the World Economic Forum—may overwhelm health systems and economies. As Ban Ki-moon, director general of the United Nations says, NCD is a threat to development.

It’s essential that research bodies fund studies to find cost effective ways of reducing the burden of NCD, said Collins. Governments are going to have to commit billions to countering NCD, and we need the evidence to ensure that investment is well spent, said Susan Shurin, chair of the Global Alliance for Chronic Diseases and acting director of the National Heart, Lung, and Blood Institute (NHLBI).

Putting together the global alliance has not been easy, said Shurin. All the members are government bodies with all the legal constraints, bureaucracy, hierarchy, and politics that implies. The research bodies use their own peer review systems and fund in parallel. But this alliance could be a model for future alliances—on perhaps mental health, injuries, and other global problems. Science and disease know no boundaries, said Collins, and global alliances are essential for global problems.

In the initial round research is being funded in Ghana, Argentina, Peru, Kenya, Nigeria, India, Fiji, Samoa, South Africa, Uganda, Rwanda, Colombia, Malaysia, Tanzania, and China. One of the aims, said Shurin, is to build a community of researchers in NCD in low and middle income countries.

We know a lot, said Shurin, about what needs to be done to reduce the burden of NCD and high blood pressure, and much of the research will be looking at how to implement in low and middle income countries what we know can work. For example, Eldoret in Kenya, which I have visited, has a wonderful programme funded by PEPFAR of visiting every household in the area to test people for HIV and treat those infected. The same programme could potentially be used to test people for high blood pressure and treat them, but who will do the testing and treating and how will the programme be organised? Levels of blood pressure are known to be high, but at the moment very few people receive any treatment—and stroke is one of the commonest causes of death in young men in Subsaharan Africa.
Global risk factors for mortality

 

 

 

 

 

Competing interest: RS is the director of the UnitedHealth Chronic Disease Initaitive, which together with NHLBI funds 11 centres in low and middle income countries doing research, building capacity, and developing policy to reduce the burden of NCD. Five of those centres have received awards from the Global Alliance for Chronic Disease.

  • Hegdebm

    Dear Richard,

    Please find out if these data are collected with pharma money’s help.The MRFIT study, at the end of the 25 years of audit, did show that the risk factors modification efforts do alter the risk factors but not the RISK. It is a boondoggle. We are using surrogate end points like reducing BP, sugar, Cholesterol etc but not looking at the long term outcomes, which are the true end points.Uffe Ravnskov’s analysis of 17 anti-hypertensive trails showed very little difference in life expectancy between treated or untreated (drug less life style modifications) patients.HOT study did show that intense drug therapy effectively lowers the BP readings but increases mortality-alters the death certificate label without altering the date!Richard let me take you back to your own article-Medical Journals are extended arms of the Pharma lobby. BPs, mostly mild and moderate, are white coat effect.All our theories become falsifiable-thus making them very scientific.  This week we have data to show that Statins in diabetics only INCREASE coronary plaques! Another Canadian study shows Statins decrease energy levels in all patients, not to speak of the protean adverse reactions!Should we not think again if we are barking up the wrong tree in our reductionist statistical science base? Modern medicine is very unscientific when we go deep. Deep down modern medicine is very, very shallow. “RCTs have been placed on an undeservedly high pedestal” Sir Michael Rawlins , Chief of NICE, in his Royal College oration in 2008.monappa(Professor BM Hegde)

  • kidmugsy

    This sentence makes no sense: “What do you think is the risk factor that causes the most deaths globally?”  A risk factor is merely a positive correlate: positive correlates may or may not be causes, may or may not be consequences, may or may not be coincidences, may or may not be statistical artefacts.

  • kidmugsy

    Geeze, why do you quote drivel such as “deaths from infection are expected to decline in the next 20 years while deaths from non-communicable disease (NCD) will increase dramatically, potentially more than wiping out all the gains from reducing deaths from infectious disease and maternal and child health problems”?  We all die.  Therefore decline in one cause of death must be matched by an increase in another.  “Wiping out gains” would imply that age at death would be unchanged.  What madness is this?