Control of hypertension in the population. Strategies in affluent and developing countries.

Control of hypertension in population. Strategies in affluent and developing countries. The control of hypertension encompasses primary prevention, early detection and adequate treatment of high blood pressure. Primary prevention involves action at the population level to reduce obesity, alcohol and salt consumption, and to increase physical activity. The management of hypertension involves diagnostic work-up, assessment of overall cardiovascular disease risk, non-pharmacological and pharmacological treatment. The majority of community control programmes emphasized detection and treatment, rather than primary prevention. There are limitations to pharmacological treatment of hypertension, as shown by various studies, where a significant proportion of hypertensives have not been controlled by the treatment applied. In addition, the blood pressure-cardiovascular risk relationship is continuous and progressive and, even within the conventionally defined "normotensive" range, complications occur with escape control. Developing countries will encounter the problem of prohibitive costs of care and drug treatment for hypertension. Therefore greater emphasis must be put on primary prevention in population control of hypertension.