Tackling the Global Hypertension Crisis: Identifying Research Priorities

Hypertension, or high blood pressure, is a major global public health issue affecting over 1.3 billion adults worldwide. It is a significant risk factor for numerous cardiovascular diseases like heart attacks, strokes, and kidney failure. Despite the availability of cost-effective treatments, only one in five people with hypertension have it under control, contributing to the enormous burden of cardiovascular diseases – the leading cause of death globally.

Recognising the urgency of addressing this crisis, the World Health Organization (WHO) has taken several initiatives to strengthen hypertension management as part of its efforts towards universal health coverage. These include launching the WHO HEARTS technical package, promoting single-pill combination therapies, developing guidelines for automated blood pressure devices, and publishing new clinical guidelines on pharmacological treatment of hypertension in adults.

However, an area that has remained unexplored is identifying research priorities for improving hypertension care delivery. To bridge this gap, the WHO recently conducted a comprehensive exercise to identify the most pressing research needs in this domain.

Through a series of webinars attended by participants from all regions, the WHO leadership team, which included Professor Alta Schutte, consolidated a list of 29 potential research priorities across five thematic areas of hypertension care. After a rigorous evaluation process, the following ten research priorities emerged as the most crucial:

1. Assessing the cost-effectiveness of combination therapy, especially single-pill combinations, in improving adherence compared to monotherapy in low- and middle-income countries (LMICs).
2. Developing and evaluating systems for delivering hypertension care closer to home, such as community clinics, centres, or even patients’ homes.
3. Determining the effectiveness and safety of task-sharing models where trained community health workers can refill, initiate, or titrate antihypertensive medications under professional supervision.
4. Evaluating task-sharing models where nurses can diagnose hypertension and initiate or adjust antihypertensive medication.
5. Identifying gaps in the medication supply chain.
6. Assessing the efficacy/effectiveness of integrated management approaches for hypertension and other clinical conditions.
7. Evaluating the effectiveness of digital approaches for improving medication adherence and patient retention.
8. Identifying optimal training and retraining approaches for healthcare workers to support task-sharing in hypertension management.
9. Conducting cost-effectiveness or cost analyses of different financing approaches for hypertension care in specific regions or countries.
10. Conducting implementation research on task-sharing approaches that address barriers in relevant settings.

By identifying these priorities, the WHO aims to provide a roadmap for researchers, funders, and policymakers to accelerate transformative research in hypertension care delivery. This effort is expected to inform implementation programs, improve control rates, and ultimately contribute to achieving universal health coverage and the Sustainable Development Goals (SDGs) related to reducing premature mortality from non-communicable diseases.

View the full report here.