World Kidney ForumHypertension in the Developing World: Challenges and Opportunities
Section snippets
Global Epidemiologic Characteristics of Hypertension
Hypertension is a key public health issue for developing countries because the complications are diverse (cardiovascular disease [CVD], stroke, and kidney failure) and treatable. Nevertheless, hypertension exacts a considerable human and economic cost. Screening for hypertension is straightforward, and with appropriate measures in place, the disease potentially is preventable, even in countries with limited resources. Kearney et al1 have analyzed the global burden of hypertension and noted that
Lifestyle Changes Associated With Urbanization
Several studies from different continents have documented the higher prevalence of hypertension in the urban versus rural population.1, 2, 3, 6, 9, 18 Tribal populations in India have been observed to have a significantly lower prevalence than in other nontribal rural centers.21 Furthermore, when tribal populations migrate to urban areas, a higher prevalence is observed.21 Urbanization often is associated with increased income and adoption of an unhealthy lifestyle. In general, risk factors
Underrecognition of Hypertension in Developing Countries
Many studies show that awareness of hypertension in the developing world population is low. In part, this likely reflects a low level of literacy and education, but also seems to reflect a low level of access to medical care. In South Asian countries, awareness correlated with poor access to treatment and therefore to control of hypertension.48 The challenge posed by low levels of awareness must be overcome through strategies targeted at education and promotion. In the SEEK study in India,
Developing Multipronged Strategies for Hypertension Management
Hypertension and its cardiovascular complications are major contributors to the global burden of disease and account for 8.1% of disability-adjusted life-years in the less developed world.51 Population trends show that CVD is becoming the leading cause of disability. In the 1990s, CVD ranked fourth after infectious and parasitic diseases, neuropsychiatric disorders, and injuries.52 However, in 2020, it is projected that CVD will become a major cause of disability and death worldwide.53
Optimal
Recommendations for Addressing Hypertension in the Developing World
In developing countries, inadequate funds, inexperience, and lack of infrastructure are important barriers to hypertension diagnosis and therapy. There frequently is competition for limited financial resources with other important communicable causes of morbidity and mortality, for example, HIV/AIDS, malaria, and tuberculosis. Furthermore, money allocated to public health initiatives is much less than that in Western nations. Collectively, these explanations for the limited progress achieved to
Acknowledgements
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Originally published online as doi:10.1053/j.ajkd.2009.06.044 on December 7, 2009.