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The World Health Organization has estimated that high blood pressure causes one in
every eight deaths, making hypertension the third leading killer in the world. Globally,
there are one billion hypertensives and four million people die annually as a direct
result of hypertension. In the Eastern Mediterranean Region, specifically, cardiovascular
diseases and stroke are becoming major causes of illness and death. They account for
31% of deaths and hypertension currently affects 26% of the adult population in the
Region. These figures are attributable to ageing populations, high rates of smoking and
changes in nutritional and behavioural habits. This necessitates setting priorities for
screening, early detection and management of hypertension to be applied and followed
among Eastern Mediterranean countries, through community-based programmes.

These include reduction of dietary sodium intake, weight loss in the overweight, physical activity,
greater dietary potassium intake and a diet with increased fresh fruit and vegetables and
reduced saturated fat intake. Smoking increases the risk of heart attack or stroke at least
three-fold in hypertensive patients, an effect that can be almost abolished if smoking
is ceased. Doctors at primary health care centres have been shown to have the most
effective frontline role in advising patients about ceasing smoking.

Primary prevention

Primary prevention is the most cost-effective approach to containing the emerging
hypertension epidemic. Obesity remains the single most important contributing factor
and, in fact, most hypertensive patients in our Region are overweight or obese. Weight
reduction reduces blood pressure and improves the effectiveness of drug therapy. A
variety of lifestyle modifications have been shown, mostly in observational studies,
to lower blood pressure and to reduce the incidence of hypertension.

Good management of hypertension is central to any strategy formulated to control
hypertension at the community level. Randomized trials of drugs that lower and control
blood pressure clearly show a reduction in mortality and morbidity but at the same time,
since hypertension is associated with cardiovascular disease and diabetes, management
and control is potentially costly.

This publication presents guidelines that recognize the complementary nature of
non-pharmacological approaches to management and pharmacotherapy and which are
cost-effective. Developing skills to apply the non-pharmacological approach presents a
challenge, as most doctors in our Region must be trained to be able to advise their patients
on a non-pharmacological approach. Countries need a cost-effective drug management
strategy that promotes adherence to medical therapy, motivates patients, builds trust
and strengthen communications between clinicians and patients and their families.

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