Hypertension affects more than 1.4 billion people worldwide, yet fewer than one in five have adequate blood pressure control. The 2025 World Health Organization global report on hypertension is clear: failure to control hypertension is no longer a problem of insufficient evidence but of insufficient implementation.
In a new BMJ editorial, Professor Anthony Etyang (KEMRI-Welcome Trust) and colleagues, call for a fundamental shift in how countries address hypertension: through stronger community engagement, equitable access to affordable medicines, and monitoring systems that drive accountability.
Highlights from the editorial include:
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Community health workers improve outcomes:
- In Bangladesh, Guatemala, Mexico and South Africa, trained community health workers achieved 96.8% diagnostic agreement with health professionals.
- In Argentina, a community‑led intervention among 1,432 low‑income adults resulted in a 21% absolute improvement in hypertension control.
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Major gaps in access to essential medicines:
Only 28% of low‑income countries have all five essential antihypertensive drug classes available, compared with 93% of high‑income countries. Stockouts, high prices, fragmented procurement and weak regulation continue to disrupt treatment continuity. -
Inequities persist across the care pathway:
In Kenya, the poorest are underscreened while the wealthiest are overrepresented among those receiving treatment. Monitoring systems must disaggregate data by income, geography, sex, and ethnicity to reveal and address inequities.