In a Seminar on essential hypertension, Franz Messerli and colleagues Lancet 2007 vol 370 pp 591 – 603 accompanied by an editorial Lancet 2007 vol 337, p 539 indicate that the risk of becoming hypertensive during lifetime exceeds 90% for a person in a developed country. The common triad of obesity, diabetes, hyperlipidaemia, and high blood pressure, if left untreated for too long, leads to cardiovascular disease, stroke, renal failure, dementia, and early death.
Worldwide, the estimated number of adults with hypertension was 972 million in 200of which 639 million live in developing countries. By 2025, the total number is expected to increase to 156 billion. Lifestyle factors, such as physical inactivity, a salt-rich diet with processed and fatty foods, and alcohol and tobacco use, are basic to this changing pattern of disease.. The problem is spreading to emerging economies, such as India and China. And even countries in Africa are noticing a sharp increase in patients with hypertension, at least in urban settings. For example, in 2006, hypertension was the second most reported medical condition in greater Accra, Ghana, up from fifth in 2005.
Hypertension remains a problematic disorder, even in developed countries with functioning health-care sys­tems, a large number of available effective treatments, and overwhelming research evidence in relevant popula­tions, for several reasons. Screening for hypertension is not done systematically and the diagnosis is often made at a late stage when target-organ damage has already happened. The optimum time to start treatment remains under discussion. As is the pressure at which treatment hould start.

Martin Eastwood
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