The George Institute For Global Health
United Kingdom

Under pressure: heart health

Worldwide, more people die from cardiovascular disease than any other cause. Alongside smoking, this is predominantly due to high blood pressure, which alone claims more than seven million lives annually. Poor diets and insufficient physical activity are key drivers to the blood pressure problem – which is true not only for developed countries, but also for the great majority of developing countries including India and China.

Blood pressure, while one of the most widely recognised health risks, is also one of the most poorly understood - both by those suffering the consequences and those trying to prevent them.  Amongst doctors and patients alike, blood pressure is seen as a problem only when it breaches a threshold, and is diagnosed as ‘hypertension’. For most of the last century, physicians have worked on this assumption. In fact, blood pressure causes disease as soon as it starts to rise, and causes significant health problems before it reaches the level traditionally diagnosed as hypertension.

This results in huge numbers of people with blood pressure levels that would previously have been considered ‘normal’ but who are in fact at a moderately increased risk. Half of all the strokes, heart attacks and diseases caused by blood pressure actually occur in people without hypertension.  

Chronic diseases are rarely caused by one thing. It’s the combined effects of multiple, different factors including cholesterol, obesity and diabetes that determine heart health. While this concept is increasingly understood by researchers, it has not yet permeated to most of the clinical community.

A tool to help health professionals better understand risk and more effectively manage patients has been developed at The George. The tool calculates the cardiovascular risk of patients, using latest research and providing tailored, real-time advice for the patient sitting in front of them.

The George is also working on the polypill, which combines multiple preventative therapies into a single pill, offering improved risk control. If combined with the better identification of those at risk and in need of therapy, we can start to close the evidence-practice gap – the yawning chasm between what research tells us we need to do to treat heart patients and what we actually manage to achieve.

Just as important as getting the medical management strategy right is improving community level risks. The impact of diet and physical activity on blood pressure is well understood but targeted in only a very cursory way. Population health campaigns such as those advocated by the Australian government’s Preventative Health Task Force and the Australian Division of World Action on Salt and Health are practical, cost-effective solutions to exposures such as salt intake, obesity and physical activity. Adding one of these ‘population blood pressure control’ interventions (salt reduction) to the current ‘clinical hypertension’ approach would increase costs by just 1-2%, but double the number of strokes and heart attacks prevented in Australia.

As with so much of medical science, discovering what do to is only half the challenge. Getting the new evidence translated into clinical practice and government policies is the real test. Strong leadership is required to move the cardiovascular prevention agenda forward. Consolidated guidelines delivered in easy-to-implement tools and a new focus on community based prevention, have enormous potential.