High blood pressure is a leading risk factor for cardiovascular diseases (CVDs) and strokes, and CVDs are the leading cause of death in the WHO European Region. WHO Regional Director for Europe Dr Hans Henri P. Kluge will launch a new Signature Initiative on 9 December 2022 that is of particular interest to the countries in the Region with the highest burden of CVDs, the highest prevalence of hypertension and poor hypertension control – and high salt consumption.
“We must now double down on our efforts to reduce the burden of CVDs by doing what we know to be effective,” said Dr Kluge. “There is growing public awareness that high blood pressure leads to strokes and heart diseases, which can in turn lead to disability or premature death. Our diets, in particular salt intake, are a major cause of hypertension.
Improving hypertension control and introducing salt-reduction strategies are best done not only by bringing together different disciplines and sectors across the health system, but also by engaging with people who have lived experience of hypertension.”
The probability of early death from a CVD – that is, death between the ages of 30 and 70 years – is almost 5 times higher in some countries in the eastern part of the Region than in those in the west.
Men are 2.5 times more likely to die prematurely from CVDs than women in some European countries. Men are also less likely to engage in health-seeking behaviour, less likely to have their hypertension well controlled and more likely to consume excessive levels of salt than women.
According to the latest data, salt consumption in almost all countries in the Region is well above recommended levels. Those in the eastern part have some of the highest levels of salt consumption globally, and some of the highest rates of hypertension regionally.
Management of blood pressure involves lifestyle changes (healthy diet, increased physical activity, avoidance of alcohol and tobacco) as well as effective treatment, supported by health system measures such as increasing access to medicines and devices, and improving the quality and organization of services.
Lowering salt intake leads to a corresponding reduction in high blood pressure. Saying no to salt may sound like an easy way to better health, but reducing a population’s salt intake requires integrated action from the food industry, the hospitality sector, and those who make education and health policies with governments.
The aim of the new Signature Initiative is to reduce inequalities in the burden of CVDs and the prevalence of high blood pressure using an integrated approach. This involves improving hypertension control in primary care and implementing population-wide salt-reduction strategies.
Managing the silent killer
Reducing high blood pressure requires successful detection, treatment and control in primary care through the implementation of simple treatment protocols. It also needs broader system support, such as access to medicines and team-based care, including advice from health professionals to reduce salt intake and foster healthy lifestyles, and effective public policies to reduce salt consumption.
“WHO/Europe’s Signature Initiative is a new, collaborative, highly targeted, pragmatic model for engaging with countries with a high CVD burden to co-define and support tailored processes for a comprehensive and integrated approach to transform cardiovascular health,” explained Dr Nino Berdzuli, Director of the Division of Country Health Programmes at WHO/Europe.
“This means building on what is already in place, developing data-driven quality improvement programmes, using digital health to engage and empower patients, and implementing a core set of salt-reduction interventions,” Dr Berdzuli added.
This is one of 6 Signature Initiatives associated with the Regional Director’s Advisory Council on Innovation for Noncommunicable Diseases. It builds on the salt-reduction package WHO/Europe produced for countries in the Region in July 2021, which promotes reformulating foods, setting national salt target levels, including salt as a criterion for food procurement in settings such as schools and hospitals, restricting marketing of unhealthy foods to children, using front-of-pack labelling, and engaging in communication campaigns.
This Signature Initiative also reinforces WHO’s work on better hypertension control through the implementation of the HEARTS package, which promotes healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technologies, risk-based CVD management, team-based care, and systems for monitoring.