Misconceptions about the short-term impact of antihypertensive drugs are contributing to a worldwide epidemic of high blood pressure, warns a recent editorial in The Lancet.

As an accompanying seminar on essential hypertension points out, the lifetime risk of becoming hypertensive is more than 90% for a person living in the developed world. Moreover, 639 million of the estimated 972 million adults with hypertension in 2000 were living in developing countries. By 2025, the total number of hypertensives is expected to reach 1.56 billion, as the disease burden spreads at “an alarming rate” from developed countries to emerging economies such as India and China, The Lancet notes.

The “increasingly common combination and interaction” of obesity, diabetes, hyperlipidaemia and high blood pressure, if left untreated for too long, leads to cardiovascular disease, stroke, renal failure, dementia and ultimately death, it adds. Yet even in developed countries with functioning healthcare systems, a large number of available, effective treatments and overwhelming research evidence in relevant populations, hypertension “remains a problematic disorder”.

The editorial suggests a number of reasons for this failing, such as lack of systematic screening, late diagnosis and flaws in risk assessment. But the “biggest problem, arguably, remains compliance”, it comments. Many people “still believe that hypertension is a disease that can be cured, and stop or reduce medication when blood pressure levels fall”.

The Lancet calls on doctors to convey the message that hypertension is “the first, and easily measurable, irreversible sign that many organs in the body are under attack”. Perhaps this will “also make people think more carefully about the consequences of an unhealthy lifestyle and help to give preventive measures a real chance of success”, it concludes.