Beaglehole

H. Grosskurth

Hendriks

Lawes

Opie

P. Lloyd-Sherlock

S. Ebrahim

English

PubMed

Crossref

International Journal of Epidemiology

Is hypertension the new HIV epidemic?

Lloyd-Sherlock, Peter

Ebrahim, Shah

Grosskurth, Heiner

University of East Anglia digital repository

EditorialIs hypertension the new HIV epidemic?At first sight, this seems a ridiculous, crassly attention-grabbing assertion. HIV infection is a sexually transmittedinfectious disease; hypertension is neither of these things.HIV is a major global health priority and is recognized as aserious threat to public health and development in manypoorer countries. Hypertension is seen as a disease of theWest, of prosperity and therefore of little relevance topoorer countries. Yet, these two conditions have a numberof important things in common.Hypertension and HIV infection are both mostlyasymptomatic, but can lead to fatal and disabling illness. Itis estimated that in 2013 hypertension was responsible forat least 45% of deaths due to heart disease and 51% ofdeaths due to stroke.1 Between 2000 and 2013, the numberof deaths attributable to hypertension rose from 7.6 to 9.4million.2,3 Projections based on available data indicate thatthe number of deaths attributable to hypertension over thenext 20 years may well exceed substantially the number re-sulting from HIV/AIDS. This is not just true on a globalscale, but for most low- and middle-income countries. InAfrica, the global burden of disease attributable to non-communicable disease is projected to increase by 27% overthe next 10 years.4Hypertension and HIV are both quite easily diagnosedthrough simple screening tests, particularly so with hyper-tension. Thanks to the roll-out of antiretroviral drugs, HIVis becoming a chronic health condition which can be man-aged through a combination of drug therapies and lifestylechange. This is also true for hypertension, and effectivedrugs are generally cheap and easily administered. From ahealth services perspective, chronic HIV infection andhypertension pose very similar challenges: they share theneed for life-long treatment, regular monitoring and a reli-able drug supply. As such, they require a major reorienta-tion for health systems that are generally geared towardsdealing with acute rather than chronic problems.For Africa as a whole, WHO estimates that antiretro-viral therapies (ARTs) are now provided to over half thepopulation who are eligible.5 By contrast, new WHO datafor Ghana and South Africa show that less than 10%of people with hypertension had access to effective treat-ment.6 One reason for low treatment rates is that, as withHIV/AIDS, the asymptomatic nature of hypertensionmeans most people living with the condition remain un-aware of it until major pathological damage has happened.For example, a recent systematic review of hypertensionstudies for Africa found awareness ranged from 10% inGhana to only 8% in Gabon.7In the early stages of the pandemic, HIV was not a con-dition associated with poor countries, but that perceptionquickly changed. Similarly, the view persists that hyperten-sion is mainly a disease of the West, despite the growingbody of evidence that prevalences in poorer countries arequickly catching up. Indeed, in some cases they are alreadyhigher than in the West. As with HIV, South Africa hasone of the highest rates of hypertension anywhere in theworld.6 And as in the early stages of the HIV pandemic,the rapid spread of hypertension to rural areas in poorcountries8 comes as a surprise. Risk factors associated withhypertension such as obesity, lack of physical exercise andunhealthy nutrition are believed to be urban problems inlow-income countries. Yet, prevalences of hypertension inrural districts are already high9,10 and in some cases havefully caught up to urban levels.11 Whereas hypertension isnot an infectious disease, the risky behaviours associatedwith it are spreading fast and seem to be as effectivelytransmitted as infectious agents. The classical dividebetween urban and rural areas is fast becoming blurred.HIV was faced with political denial and public misun-derstanding in the early years of the pandemic, especiallyin some poorer countries. There is a similar pattern of de-nial with hypertension. Worryingly, this can also be seen atVC The Author 2014. Published by Oxford University Press on behalf of the International Epidemiological AssociationThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com 1International Journal of Epidemiology, 2014, 1–3doi: 10.1093/ije/dyu019 Int. J. Epidemiol. Advance Access published February 3, 2014 at University of East Anglia on February 12, 2014http://ije.oxfordjournals.org/Downloaded from the international level: hypertension and associated cardio-vascular conditions accounted for less than 3% of globalhealth assistance between 2001 and 2008.12 This denial isbased on the misguided view that hypertension does not af-fect poorer social groups. Yet there is substantial evidencethat hypertension is highly prevalent among poorer groupsand that they are less likely to have access to effective treat-ment.6 As with HIV, hypertension can be both a cause anda consequence of poverty. For example, a national surveyin China found that 37% of patients and their families fellbelow a US$1-a-day poverty line within 3 months of expe-riencing stroke.13Rather than being understood as a condition of poverty,HIV remains a highly stigmatized condition and continuesto be blamed on irresponsible personal behaviour. Tosome extent the same is true of hypertension, which is cau-sally linked with behavioural factors such as obesity, highsalt intake and alcohol consumption and tends to clusterwith other risk factors—smoking, physical inactivity—forcardiovascular disease. In the West it is increasingly recog-nized that explaining these behaviours in terms of individ-uals’ moral shortcomings is unhelpful and misses thebigger picture of structural and environmental causes.There is less evidence of this enlightened approach amongpolicy-makers in poorer countries or in international agen-cies, who struggle to persuade funders and taxpayers tohelp people who ‘eat and smoke too much’.The 2011 UN Assembly of Heads of States noted withconcern that ‘the rapidly growing magnitude of non-com-municable diseases (NCDs) affects people of all ages, gen-der, race and income levels, and…that poor populationsand those living in vulnerable situations, in particular indeveloping countries bear a disproportionate burden’.14Several developing countries have set up national NCDcontrol programmes, but most of these remain a low prior-ity and implementation creeps along with frustrating slow-ness: a situation very reminiscent of the slow build-up ofAIDS control programmes in developing countries prior to1990.Recent editions of IJE have featured a debate about theextent to which global health policy priorities should shiftfrom infectious diseases such as HIV to non-communicablediseases such as hypertension.15–23 This debate has mainlypivoted on a social gradient ‘beauty contest’, disputing thepace at which conditions such as hypertension are spread-ing to relatively poorer groups. As argued by Remais et al.in IJE, rather than framing policy as a choice betweencompeting priorities, the key challenge is to roll out ser-vices and interventions which address both.24 At the sametime, it has been suggested that valuable lessons regardinghypertension could be taken from HIV/AIDS policies.25Yet there is little indication that these lessons are beingtaken on board. Our response to the global epidemic ofhypertension seems little better than our response to HIV/AIDS two decades ago: too little too late. Can we not wakeup earlier this time, before millions have died?Peter Lloyd-Sherlock, School of International Develop-ment, University of East Anglia, Norwich ResearchPark, Norwich, NR4 7TJ.E-mail: p.lloyd-sherlock@uea.ac.ukShah Ebrahim, London School of Hygiene & TropicalMedicine, London, UK, andHeiner Grosskurth, Medical Research Council /Uganda Virus Institute, Entebbe, UgandaReferences1. World Health Organization (WHO). A Global Brief onHypertension. 2013. www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/ (10 January 2014,date last accessed).2. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessmentof burden of disease and injury attributable to 67 risk factorsand risk factor clusters in 21 regions, 1990-2010: a systematicanalysis for the Global Burden of Disease Study 2010. Lancet2012;380:2224–60.3. Lawes CMM, Vander Hoorn S, Rodgers A. Global burden ofblood pressure-related disease, 2001. Lancet 2008;371:1513–18.4. World Health Organization (WHO). Global Status Report onNoncommunicable Diseases 2010. http://www.who.int/nmh/publications/ncd_report2010/en/ (4 December 2013, date lastaccessed).5. WHO, Global Health Observatory. Antiretroviral Therapy(ART) Coverage Among All Age Groups. http://www.who.int/gho/hiv/epidemic_response/ART_text/en/ (4 December 2013,date last accessed).6. Lloyd-Sherlock P, Minicuci N, Beard J, Ebrahim S, Chatterji S.Hypertension among older adults in low and middle incomecountries: prevalence, awareness and control. Int J Epidemiol2014; doi:10.1093/ije/dyt215.7. Kayima J, Wanyenze R, Katamba A, Leontsini E, Nuwaha F.Hypertension awareness, treatment and control in Africa: a sys-tematic review. BMCCardiovasc Disord 2013;13:54.8. Opie LH, Seedat YK. Hypertension in sub-saharan African pop-ulations. Circulation 2005;112: 3562-689. Hendriks M, Wit F, Roos M, Brewster L, Akande T, de Beer I,et al. Hypertension in sub-saharan Africa: cross-sectional surveysin four rural and urban communities. PLoS ONE 2012;7:e32638.10. Murphy GA, Asiki G, Ekoru K et al. Sociodemographic distribu-tion of non-communicable disease risk factors in rural Uganda: across-sectional study. Int J Epidemiol 2013; doi:10.1093/ije/dyt184.11. Addo J, Smeeth L, Leon D. Hypertension in sub-Saharan Africa:a systematic review.Hypertension 2007;50:1012–18.12. Nugent R, Feigl A. Where Have All the Donors Gone? ScarceDonor Funding for Non-Communicable Diseases. Centre forGlobal Development Working Paper 228, Washington DC.International Journal of Epidemiology 2 at University of East Anglia on February 12, 2014http://ije.oxfordjournals.org/Downloaded from 2010. http://www.cgdev.org/publication/where-have-all-donors-gone-scarce-donor-funding-non-communicable-diseases-working-paper (4 December 2013, date last accessed).13. Heeley E, Anderson C, Huang Y et al. Role of health insurance inaverting economic hardship in families after acute stroke inChina. Stroke 2009;40:2149–56.14. United Nations. Political declaration of the High-level Meetingof the General Assembly on the Prevention and Control of Non-communicable Diseases. UN General Assembly, 19 September2011. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf (4 December 2013, date lastaccessed).15. Subramanian SV, Corsi DJ, Subramanyam MA, Davey Smith G.Jumping the gun: the problematic discourse on socioeconomicstatus and cardiovascular health in India. Int J Epidemiol2013;42:1410–26.16. Gwatkin D. Metrics matter: the case of assessing the importanceof non-communicable diseases for the poor. Int J Epidemiol2013;42:1211–14.17. Stringhini S, Bovet P. Commentary: The social transition ofcardiovascular disease in low- and middle-income countries:wait and see is not an option. Int J Epidemiol 2013;42:1429–31.18. Narayan KMV, Ali MK. Commentary: Shielding against a futureinferno: the not-so-problematic discourse on socioeconomicstatus and cardiovascular health in India. Int J Epidemiol 2013;42: 1426-29.19. Prabhakaran D, Jeemon J, Reddy KS. Commentary: Poverty andcardiovascular disease in India: do we need more evidence foraction? Int J Epidemiol 2013; 42: 1431-35.20. Jones-Smith JC. Commentary: Jumping the gun or asleep at theswitch: is there a middle ground? Int J Epidemiol 2013; 42:1435-37.21. Subramanian SV, Subramanyam MA, Corsi DJ, Davey Smith G.Rejoinder: need for a data-driven discussion on the socioeco-nomic patterning of cardiovascular health in India. Int JEpidemiol 2013; 42: 1438-43.22. Gupta P and Pednekar M. Re: Jumping the gun: the problematicdiscourse on socioeconomic status and cardiovascular health inIndia. Int J of Epidemiol 2014;doi:10.1093/ije/dyt24423. Corsi DJ, Subramanian MS, Davey Smith G, Subramanian SV.Authors’ response to Gupta and Pednekar: importance of exam-ining cause-specific proportions of deaths as well as mortalityrates. Int J Epidemiol 2013; doi:10.1093/ije/dyt24524. Remais JV, Zeng G, Li G, Tian L, Engelgau M. Convergence ofnon-communicable and infectious diseases in low- and middle-income countries option. Int J Epidemiol 2012;42:221–27.25. Beaglehole R, Bonita R, Alleyne G et al. UN High-Level Meetingon Non-Communicable Diseases: addressing four questions.Lancet 2011;378:449–55.3 Is hypertension the new HIV epidemic? at University of East Anglia on February 12, 2014http://ije.oxfordjournals.org/Downloaded from 

LSHTM Research Online

Lloyd-Sherlock, P; Ebrahim, S; Grosskurth, H (2014) Is hypertensionthe new HIV epidemic? International journal of epidemiology. ISSN0300-5771 DOI: 10.1093/ije/dyu019Downloaded from: http://researchonline.lshtm.ac.uk/1520179/DOI: 10.1093/ije/dyu019Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: http://creativecommons.org/licenses/by/2.5/EditorialIs hypertension the new HIV epidemic?At first sight, this seems a ridiculous, crassly attention-grabbing assertion. HIV infection is a sexually transmittedinfectious disease; hypertension is neither of these things.HIV is a major global health priority and is recognized as aserious threat to public health and development in manypoorer countries. Hypertension is seen as a disease of theWest, of prosperity and therefore of little relevance topoorer countries. Yet, these two conditions have a numberof important things in common.Hypertension and HIV infection are both mostlyasymptomatic, but can lead to fatal and disabling illness. Itis estimated that in 2013 hypertension was responsible forat least 45% of deaths due to heart disease and 51% ofdeaths due to stroke.1 Between 2000 and 2013, the numberof deaths attributable to hypertension rose from 7.6 to 9.4million.2,3 Projections based on available data indicate thatthe number of deaths attributable to hypertension over thenext 20 years may well exceed substantially the number re-sulting from HIV/AIDS. This is not just true on a globalscale, but for most low- and middle-income countries. InAfrica, the global burden of disease attributable to non-communicable disease is projected to increase by 27% overthe next 10 years.4Hypertension and HIV are both quite easily diagnosedthrough simple screening tests, particularly so with hyper-tension. Thanks to the roll-out of antiretroviral drugs, HIVis becoming a chronic health condition which can be man-aged through a combination of drug therapies and lifestylechange. This is also true for hypertension, and effectivedrugs are generally cheap and easily administered. From ahealth services perspective, chronic HIV infection andhypertension pose very similar challenges: they share theneed for life-long treatment, regular monitoring and a reli-able drug supply. As such, they require a major reorienta-tion for health systems that are generally geared towardsdealing with acute rather than chronic problems.For Africa as a whole, WHO estimates that antiretro-viral therapies (ARTs) are now provided to over half thepopulation who are eligible.5 By contrast, new WHO datafor Ghana and South Africa show that less than 10%of people with hypertension had access to effective treat-ment.6 One reason for low treatment rates is that, as withHIV/AIDS, the asymptomatic nature of hypertensionmeans most people living with the condition remain un-aware of it until major pathological damage has happened.For example, a recent systematic review of hypertensionstudies for Africa found awareness ranged from 10% inGhana to only 8% in Gabon.7In the early stages of the pandemic, HIV was not a con-dition associated with poor countries, but that perceptionquickly changed. Similarly, the view persists that hyperten-sion is mainly a disease of the West, despite the growingbody of evidence that prevalences in poorer countries arequickly catching up. Indeed, in some cases they are alreadyhigher than in the West. As with HIV, South Africa hasone of the highest rates of hypertension anywhere in theworld.6 And as in the early stages of the HIV pandemic,the rapid spread of hypertension to rural areas in poorcountries8 comes as a surprise. Risk factors associated withhypertension such as obesity, lack of physical exercise andunhealthy nutrition are believed to be urban problems inlow-income countries. Yet, prevalences of hypertension inrural districts are already high9,10 and in some cases havefully caught up to urban levels.11 Whereas hypertension isnot an infectious disease, the risky behaviours associatedwith it are spreading fast and seem to be as effectivelytransmitted as infectious agents. The classical dividebetween urban and rural areas is fast becoming blurred.HIV was faced with political denial and public misun-derstanding in the early years of the pandemic, especiallyin some poorer countries. There is a similar pattern of de-nial with hypertension. Worryingly, this can also be seen atInternational Journal of Epidemiology, 2014, 8–10doi: 10.1093/ije/dyu019Advance Access Publication Date: 3 February 2014VC The Author 2014. Published by Oxford University Press on behalf of the International Epidemiological AssociationThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com 8the international level: hypertension and associated cardio-vascular conditions accounted for less than 3% of globalhealth assistance between 2001 and 2008.12 This denial isbased on the misguided view that hypertension does not af-fect poorer social groups. Yet there is substantial evidencethat hypertension is highly prevalent among poorer groupsand that they are less likely to have access to effective treat-ment.6 As with HIV, hypertension can be both a cause anda consequence of poverty. For example, a national surveyin China found that 37% of patients and their families fellbelow a US$1-a-day poverty line within 3 months of expe-riencing stroke.13Rather than being understood as a condition of poverty,HIV remains a highly stigmatized condition and continuesto be blamed on irresponsible personal behaviour. Tosome extent the same is true of hypertension, which is cau-sally linked with behavioural factors such as obesity, highsalt intake and alcohol consumption and tends to clusterwith other risk factors—smoking, physical inactivity—forcardiovascular disease. In the West it is increasingly recog-nized that explaining these behaviours in terms of individ-uals’ moral shortcomings is unhelpful and misses thebigger picture of structural and environmental causes.There is less evidence of this enlightened approach amongpolicy-makers in poorer countries or in international agen-cies, who struggle to persuade funders and taxpayers tohelp people who ‘eat and smoke too much’.The 2011 UN Assembly of Heads of States noted withconcern that ‘the rapidly growing magnitude of non-com-municable diseases (NCDs) affects people of all ages, gen-der, race and income levels, and…that poor populationsand those living in vulnerable situations, in particular indeveloping countries bear a disproportionate burden’.14Several developing countries have set up national NCDcontrol programmes, but most of these remain a low prior-ity and implementation creeps along with frustrating slow-ness: a situation very reminiscent of the slow build-up ofAIDS control programmes in developing countries prior to1990.Recent editions of IJE have featured a debate aboutthe extent to which global health policy prioritiesshould shift from infectious diseases such as HIV tonon-communicable diseases such as hypertension.15–23This debate has mainly pivoted on a social gradient‘beauty contest’, disputing the pace at which conditionssuch as hypertension are spreading to relatively poorergroups. As argued by Remais et al. in IJE, rather thanframing policy as a choice between competing priorities,the key challenge is to roll out services and interven-tions which address both.24 At the same time, it hasbeen suggested that valuable lessons regarding hyperten-sion could be taken from HIV/AIDS policies.25 Yet thereis little indication that these lessons are being taken onboard. Our response to the global epidemic of hyperten-sion seems little better than our response to HIV/AIDStwo decades ago: too little too late. Can we not wakeup earlier this time, before millions have died?Peter Lloyd-Sherlock, School of International Develop-ment, University of East Anglia, Norwich ResearchPark, Norwich, NR4 7TJ.E-mail: p.lloyd-sherlock@uea.ac.ukShah Ebrahim, London School of Hygiene & TropicalMedicine, London, UK, andHeiner Grosskurth, Medical Research Council /Uganda Virus Institute, Entebbe, UgandaReferences1. World Health Organization (WHO). A Global Brief onHypertension. 2013. www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/ (10 January 2014,date last accessed).2. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessmentof burden of disease and injury attributable to 67 risk factorsand risk factor clusters in 21 regions, 1990-2010: a systematicanalysis for the Global Burden of Disease Study 2010. Lancet2012;380:2224–60.3. Lawes CMM, Vander Hoorn S, Rodgers A. Global burden ofblood pressure-related disease, 2001. Lancet 2008;371:1513–18.4. World Health Organization (WHO). Global Status Report onNoncommunicable Diseases 2010. http://www.who.int/nmh/publications/ncd_report2010/en/ (4 December 2013, date lastaccessed).5. WHO, Global Health Observatory. Antiretroviral Therapy(ART) Coverage Among All Age Groups. http://www.who.int/gho/hiv/epidemic_response/ART_text/en/ (4 December 2013,date last accessed).6. Lloyd-Sherlock P, Minicuci N, Beard J, Ebrahim S, Chatterji S.Hypertension among older adults in low and middle incomecountries: prevalence, awareness and control. Int J Epidemiol2014;43:116–28.7. Kayima J, Wanyenze R, Katamba A, Leontsini E, Nuwaha F.Hypertension awareness, treatment and control in Africa: a sys-tematic review. BMCCardiovasc Disord 2013;13:54.8. Opie LH, Seedat YK. Hypertension in sub-saharan African pop-ulations. Circulation 2005;112: 3562-689. Hendriks M, Wit F, Roos M, Brewster L, Akande T, de Beer I,et al. Hypertension in sub-saharan Africa: cross-sectional surveysin four rural and urban communities. PLoS ONE 2012;7:e32638.10. Murphy GA, Asiki G, Ekoru K et al. Sociodemographic distribu-tion of non-communicable disease risk factors in rural Uganda: across-sectional study. Int J Epidemiol 2013;42:1740–53.11. Addo J, Smeeth L, Leon D. Hypertension in sub-Saharan Africa:a systematic review.Hypertension 2007;50:1012–18.12. Nugent R, Feigl A. Where Have All the Donors Gone? ScarceDonor Funding for Non-Communicable Diseases. Centre forGlobal Development Working Paper 228, Washington DC.9 International Journal of Epidemiology, 2014, Vol. 43, No. 12010. http://www.cgdev.org/publication/where-have-all-donors-gone-scarce-donor-funding-non-communicable-diseases-working-paper (4 December 2013, date last accessed).13. Heeley E, Anderson C, Huang Y et al. Role of health insurance inaverting economic hardship in families after acute stroke inChina. Stroke 2009;40:2149–56.14. United Nations. Political declaration of the High-level Meetingof the General Assembly on the Prevention and Control of Non-communicable Diseases. UN General Assembly, 19 September2011. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf (4 December 2013, date lastaccessed).15. Subramanian SV, Corsi DJ, Subramanyam MA, Davey Smith G.Jumping the gun: the problematic discourse on socioeconomicstatus and cardiovascular health in India. Int J Epidemiol2013;42:1410–26.16. Gwatkin D. Metrics matter: the case of assessing the importanceof non-communicable diseases for the poor. Int J Epidemiol2013;42:1211–14.17. Stringhini S, Bovet P. Commentary: The social transition ofcardiovascular disease in low- and middle-income countries:wait and see is not an option. Int J Epidemiol 2013;42:1429–31.18. Narayan KMV, Ali MK. Commentary: Shielding against a futureinferno: the not-so-problematic discourse on socioeconomicstatus and cardiovascular health in India. Int J Epidemiol 2013;42: 1426-29.19. Prabhakaran D, Jeemon J, Reddy KS. Commentary: Poverty andcardiovascular disease in India: do we need more evidence foraction? Int J Epidemiol 2013; 42: 1431-35.20. Jones-Smith JC. Commentary: Jumping the gun or asleep at theswitch: is there a middle ground? Int J Epidemiol 2013; 42:1435-37.21. Subramanian SV, Subramanyam MA, Corsi DJ, Davey Smith G.Rejoinder: need for a data-driven discussion on the socioeco-nomic patterning of cardiovascular health in India. Int JEpidemiol 2013; 42: 1438-43.22. Gupta P and Pednekar M. Re: Jumping the gun: the problematicdiscourse on socioeconomic status and cardiovascular health inIndia. Int J of Epidemiol 2014;43:276–8.23. Corsi DJ, Subramanian MS, Davey Smith G, Subramanian SV.Authors’ response to Gupta and Pednekar: importance of exam-ining cause-specific proportions of deaths as well as mortalityrates. Int J Epidemiol 2014;43:278–80.24. Remais JV, Zeng G, Li G, Tian L, Engelgau M. Convergence ofnon-communicable and infectious diseases in low- and middle-income countries option. Int J Epidemiol 2012;42:221–27.25. Beaglehole R, Bonita R, Alleyne G et al. UN High-Level Meetingon Non-Communicable Diseases: addressing four questions.Lancet 2011;378:449–55.International Journal of Epidemiology, 2014, Vol. 43, No. 1 10

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study

Authors’ response to Gupta and Pednekar: importance of examining cause-speciﬁc proportions of deaths as well as mortality rates.

Commentary: Jumping the gun or asleep at the switch: is there a middle ground?

Commentary: Poverty and cardiovascular disease in India: do we need more evidence for action?

Commentary: Shielding against a future inferno: the not-so-problematic discourse on socioeconomic status and cardiovascular health in India.

Convergence of non-communicable and infectious diseases in low- and middleincome countries option.

Global burden of blood pressure-related disease,

Health Observatory. Antiretroviral Therapy (ART) Coverage Among All Age Groups.

Hypertension among older adults in low and middle income countries: prevalence, awareness and control.

Hypertension awareness, treatment and control in Africa: a systematic review.

Hypertension in sub-Saharan Africa: a systematic review. Hypertension

Hypertension in sub-saharan Africa: cross-sectional surveys in four rural and urban communities.

Hypertension in sub-saharan African populations.

Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India.

Metrics matter: the case of assessing the importance of non-communicable diseases for the poor.

Organization (WHO). A Global Brief on Hypertension.

Organization (WHO). Global Status Report on Noncommunicable Diseases

Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases.

Rejoinder: need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India.

Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke

Sociodemographic distribution of non-communicable disease risk factors in rural Uganda: a cross-sectional study.

The social transition of cardiovascular disease in low- and middle-income countries: wait and see is not an option.

UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet 2011;378:449–55.

Where Have All the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases. Centre for Global Development Working Paper 228,

Is hypertension the new HIV epidemic?

Abstract

Similar works

Full text

Available Versions

Crossref

University of East Anglia digital repository

LSHTM Research Online