https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
245
HYPERTENSION: A GLOBAL HEALTH CHALLENGE
Senior Lecturer, Department of Medical Biology and Histology
Umarova Zulfizar Makhamadzokirovna
Andijan State Medical Institute
1. Introduction
Hypertension, also known as high blood pressure, is a chronic medical
condition where the blood pressure in the arteries is persistently elevated. It is often
called the “silent killer” because it typically has no symptoms until significant
organ damage occurs. According to the World Health Organization (WHO),
hypertension affects more than 1.28 billion adults worldwide, and nearly 46% of
adults with hypertension are unaware they have the condition.
2. Epidemiology
Hypertension is prevalent across all populations, but its incidence increases
with age, urbanization, dietary habits, and sedentary lifestyles. Globally, about 34%
of men and 32% of women are affected. The prevalence in low- and middle-income
countries is significantly high due to limited healthcare access.
3. Risk Factors
Risk factors for hypertension are categorized into modifiable and non-
modifiable types. Modifiable factors are lifestyle-related and can be improved
through behavioral changes, while non-modifiable factors are related to age,
genetics, or medical conditions.
4. Classification and Pathophysiology
The ACC/AHA 2017 Guidelines classify hypertension as follows:
- Normal: <120 / <80 mmHg
- Elevated: 120
–
129 / <80 mmHg
- Stage 1 Hypertension: 130
–
139 / 80
–
89 mmHg
https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
246
-
Stage 2 Hypertension: ≥140 / ≥90 mmHg
Primary (essential) hypertension accounts for about 90
–
95% of cases and results
from a combination of genetic and environmental factors. Secondary
hypertension is caused by identifiable medical conditions such as kidney disease,
endocrine disorders, or medication use.
5. Clinical Impact
If left untreated, hypertension can cause stroke, heart attack, heart failure,
chronic kidney disease, vision loss, and cognitive decline. According to the CDC
(2023), around 685,000 deaths in the U.S. in 2022 were directly related to
hypertension.
Graph 1 Description: Bar graph showing increasing global mortality attributed to
hypertension from 2000 to 2022, peaking around 10.5 million deaths annually.
6. Diagnosis and Monitoring
Diagnosis requires multiple blood pressure readings over time. Methods
include office BP measurements, home BP monitoring, and ambulatory BP
monitoring.
Graph 2 Description: A line graph illustrating that although diagnosis and treatment
rates have improved slightly since 2000, control rates remain low.
7. Management
Lifestyle Modifications:
- Adopt the DASH diet
- Reduce salt intake (<5g/day)
- Engage in regular physical activity
- Limit alcohol and stop smoking
https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
247
Medications:
- ACE inhibitors / ARBs
- Calcium channel blockers
- Thiazide diuretics
- Beta-blockers
Combination therapy is often necessary to achieve target BP levels.
8. Public Health and Prevention
WHO’s 'HEARTS' initiative promotes public education, community
screening, salt reduction policies, access to affordable medications, and health
system
strengthening.
WHO Goal: Reduce the global prevalence of hypertension by 25% by 2025.
Among individuals with untreated or uncontrolled hypertension, elevated
systolic blood pressure with a diastolic pressure of less than 90 mm Hg often
remains a problem. Hyman and Pavlik, using the same NHANES data set,
conducted an analysis of blood pressure levels in individuals with uncontrolled
hypertension (Hyman and Pavlik, 2001). They found that close to 80 percent of
individuals with hypertension present but who were unaware had a systolic blood
pressure ≥140 mm Hg and a diastolic blood pressure <90
mm Hg. The actual
awareness, treatment, and control rates are likely higher than the NHANES
estimates due to the definition of hypertension in the study. In the NHANES, the
diagnosis of hypertension was based on blood pressure measurement at a single
clinical visit, whereas national guidelines recommend that the classification of
hypertension be based on the mean of two or more blood pressure readings taken
during two or more office visits (Chobanian et al., 2003). Thus, some of the
https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
248
individuals classified as unaware and untreated hypertensive might not meet the
criteria for hypertension in the clinical setting. Although the proportion of
individuals with controlled hypertension has increased substantially, the majority
(65 percent) of individuals with hypertension are not under control. Wang and
Vasan (2005) highlighted factors associated with uncontrolled hypertension in the
United States, categorized by patient and physician factors. Patient factors related
to uncontrolled hypertension include lack of insurance and provider, increased
susceptibility due to advanced age and obesity, therapy nonadherence because of
medication cost, complicated regimens, lack of social support, and poor physician-
patient communication. Physician factors related to uncontrolled hypertension
include lack of knowledge about guidelines, overestimating guideline adherence,
concerns about medication side effects, and limited office visit time.
Table 1. Global Hypertension Prevalence
Region
Prevalence (%)
Global (Men)
34
Global (Women)
32
United States
47.7
Sri Lanka
34.8
LMICs (average)
~40
–
50
Table 2. Risk Factors for Hypertension
Modifiable Factors
Non-Modifiable Factors
https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
249
High sodium intake
Age (>65 years)
Obesity
Family history
Physical inactivity
Ethnicity (e.g., African)
Alcohol and tobacco use
Chronic kidney disease
Table 3. U.S. Hypertension Cascade (2021
–
2023)
Stage
Percentage (%)
Diagnosed
59.2
On medication
51.2
Blood pressure controlled
22.5
9. Conclusion
Hypertension is one of the leading causes of death and disability worldwide.
Early detection, lifestyle changes, and consistent treatment can prevent
complications. Global cooperation, policy changes, and community engagement
are essential to reduce the burden of this silent killer. Data collection is fundamental
to addressing any public health problem. Data are critical for determining the
burden of hypertension, characterizing the patterns among subgroups of the
population, assessing changes in the problem over time, and evaluating the success
of interventions. Given the challenges posed by the changing methodologies used
to collect blood pressure measurements, the committee believes that efforts to
strengthen hypertension surveillance and monitoring are critical.
References
1. World Health Organization. Hypertension Fact Sheet, 2021.
https://scientific-jl.com/luch/
Часть
-46
_ Том
-5_
июнь
-2025
250
2. Centers for Disease Control and Prevention (CDC). High Blood Pressure,
2023.
3. Whelton PK et al. 2017 ACC/AHA Guidelines. J Am Coll Cardiol.
4. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors.
5. Muntner P et al. Trends in BP Control Among US Adults, 1999
–
2018.
JAMA.
6,Apostolides, A. Y., G. Cutter, S. A. Daugherty, R. Detels, J. Kraus, S.
Wassertheil-Smoller, and J. Ware. 1982. Three-year incidence of hypertension in
thirteen U.S. Communities. On behalf of the hypertension detection and follow-up
program cooperative group.
Preventive Medicine
11(5):487-499. [PubMed]
7.Berenson, G., S. Srinivasan, W. Chen, S. Li, D. Patel, and G. Bogalusa Heart
Study. 2006. Racial (black-white) contrasts of risk for hypertensive disease in
youth have implications for preventive care: The Bogalusa Heart Study.
Ethnicity
& Disease
16(3 Suppl 4):S4-2-9. [PubMed]
8.Briefel, R. R., and C. L. Johnson. 2004. Secular trends in dietary intake in
the United States.
Annual Review of Nutrition
24:401-431. [PubMed]
9.Burt, V. L., J. A. Cutler, M. Higgins, M. J. Horan, D. Labarthe, P. Whelton,
C. Brown, and E. J. Roccella. 1995. Trends in the prevalence, awareness, treatment,
and control of hypertension in the adult US population. Data from the health
examination surveys, 1960 to 1991.
Hypertension
26(1):60-69. [PubMed]
