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World J Hypertens. Feb 23, 2017; 7(1): 19-23
Published online Feb 23, 2017. doi: 10.5494/wjh.v7.i1.19
Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies
Khaled Salem, Abdulhalim Jamal Kinsara
Khaled Salem, King Abdullah Medical City, Makkah 21955, Saudi Arabia
Abdulhalim Jamal Kinsara, King Abdul Aziz Medical City, King Faisal Cardiac Center, Jeddah 21423, Saudi Arabia
Author contributions: All the authors contributed to the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Abdulhalim Jamal Kinsara, Associate Professor, Consultant Cardiology, King Saud bin Abdulaziz University for Health Sciences, COM-WR, King Abdul Aziz Medical City, King Faisal Cardiac Center, Mail code 6599, P.O. Box 9515, Jeddah 21423, Saudi Arabia. kinsaraaj@ngha.med.sa
Telephone: +966-12-2266666 Fax: +966-12-0008668
Received: August 5, 2016
Peer-review started: August 7, 2016
First decision: September 28, 2016
Revised: October 15, 2016
Accepted: November 27, 2016
Article in press: November 29, 2016
Published online: February 23, 2017
Processing time: 195 Days and 10.9 Hours
Abstract

In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges and opportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries (141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80s and the first decade of the 20th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.

Keywords: Hypertension; Screening; Low and middle-income countries; Socioeconomic characteristics; Strategic framework

Core tip: The burden of hypertension in middle-income countries is high. There are many challenges and opportunities, including lack of reliable accurate data and facing the existing correlation between socioeconomic characteristics and hypertension. A few successful models are presented and we suggest a strategic framework that would promote Population health approach.