Complications of hypertension are associated with an estimated 9.4 million deaths worldwide every year . In 2008, globally, the overall prevalence of hypertension (including those on medication for high blood pressure) in adults aged 25 and over was around 40% . On average, global population systolic blood pressure decreased slightly between 1980 and 2008 [3, 4], although the worldwide prevalence of obesity has nearly doubled during this period. In 2008, the global prevalence of high cholesterol was 40% and prevalence of diabetes was 10% in adults over 25 years .
Most people with diabetes and hypertension also have other cardiovascular risk factors such as raised lipids [1, 2]. To reduce the prevalence and consequences of hypertension and diabetes a complimentary mixture of population-wide and individual interventions is required. To ensure optimal coverage of the population with these interventions implementation of public health policies has to be complimented with a health system which addresses hypertension through affordable strategies [2, 5]. An approach that relies mainly on the overall risk of individuals is likely to be more cost effective than one focused solely on blood pressure levels or targets.
There are many barriers to the control of hypertension and diabetes in low- and middle-income countries. They include the double burden of communicable and noncommunicable diseases, inadequate investment in health and prevention, fragile health systems particularly at primary care level, and lack of or maldistribution of health workers. Several countries spend less than 50 USD per capita per year on health. This low level of investment is inadequate to effectively address noncommunicable diseases in a sustainable manner .
To address cardiovascular disease, diabetes, and noncommunicable diseases a set of core interventions (Table 1)have been identified which are highly cost effective, affordable, and feasible to implement even in resource-constrained settings . These interventions address diabetes, hypertension, and their key underlying risk factors--unhealthy diet, harmful use of alcohol, and physical inactivity. Some of these interventions are feasible in primary care even in low-resource settings. For example, people at risk of heart attacks and stroke usually have a modest elevation of multiple risk factors, such as smoking, raised blood pressure, raised cholesterol, and/or diabetes. Such people who have medium...