High blood pressure, also called 'hypertension,' has become quite a common health problem among adults worldwide, with over one billion cases reported in 2019. When blood pressure is not properly controlled, the heart undergoes adaptive changes at the macroscopic and microscopic levels, affecting its valves, chambers, and muscles. This condition, known as hypertensive hearth disease (HHD), can cause permanent remodeling of the heart over time, affecting its normal function and ultimately leading to heart failure.
Today, over 15 million people worldwide suffer from HDD, which has become the second leading cause of heart failure. Thus, HDD represents a massive challenge in healthcare that needs to be urgently addressed. Although HDD manifests mainly in older adults, there is limited data on its trends in this population.
To tackle this problem, a research team from the Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China conducted a comprehensive statistical analysis on the impact of HHD among older adults (60–89 years old) at the global, regional, and national levels. Their study, which was led by Professor Jun Cai, was published in the Chinese Medical Journal and made available online on September 12, 2023. "HHD remains a major concern in the management of hypertension and an important public health challenge," says Prof. Cai.
The data for this study came from the Global Burden of Disease Study 2019 project. Using its publicly available dataset, the researchers estimated the incidence, prevalence, mortality, and disability-adjusted life years (DALY) associated with HHD of 204 countries by age, sex, location, and year between 1990 and 2019.
The authors noted that there was an overall increase in the global prevalence of HHD between 1990 and 2019, but a decrease in mortality and DALY rates. This pattern was mostly maintained for both sexes across all age groups, as well as for sociodemographic index (SDI), which summarizes health-related social and economic development indicators. Unfortunately, these results paint a particularly difficult situation for healthcare systems, as higher prevalence but lower mortality imply that more people will require treatment for HHD. "We observed the largest increasing trend in the prevalence of HHD since 2017 with a slowing of decreasing trends in HHD-related mortality and DALY rate since 2014," highlights Prof. Cai, "This finding suggests that we are presently facing even more rapid growth of the burden of HHD, which needs urgent attention."
Interestingly, the results for males and females were considerably different in a few regards. While males exhibited a higher prevalence of HHD, females had higher mortality and DALY rates. This suggests that the management of cardiovascular diseases in females is less effective, leading to worse prognosis. Moreover, the increasing trend of HHD prevalence was also higher in females, with a steep increase in 2017. Thus, the gap in prevalence between males and females seems to be narrowing. "Our findings highlight disparities in the disease burden between the sexes, and the burden of HHD in older females should not be ignored," remarks Prof. Cai.
Worth noting, there were significant differences in the indicators for HHD between different countries and for different SDI groups. Overall, there were 85 countries with a significant increasing trend in HHD prevalence and 81 with a significant decreasing trend between 1990 and 2019. Notably, high-income Asia-Pacific countries (such as Japan, Singapore, and South Korea) exhibited the largest increase in HHD prevalence, but also the largest decrease in HHD mortality and DALY rate. Despite the increasingly aging population in these countries contributing to the prevalence of HHD, it appears that they have managed to keep risk factors in check by providing adequate healthcare and keeping their populations informed.
Taken together, the study sheds light on the burden of HHD at the global, regional, and national level and provides a solid groundwork for the development of strategies to combat this challenging disorder. "There are gaps in the prevention, management, and treatment of HHD world-wide," concludes Prof. Cai, "Our findings regarding the current situation of HHD and its temporal trends highlight inequities in the burden of HHD among older adults globally as well as a need for public health interventions at the individual and population levels."
Let us hope further research efforts pave the way to a future where serious cardiovascular diseases are the exception rather than the norm.
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Reference
Titles of original papers: Global, regional, and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019: a trend analysis
Journal: Chinese Medical Journal
DOI: https://doi.org/10.1097/CM9.0000000000002863
