Programmatic approach to the prevention and control of hypertension as a key reserve for reducing mortality in the Russian Federation

Hypertension (HTN) is a powerful risk factor for cardiovascular disease and related mortality in the Russian population. The epidemiological studies ESSE-RF, ESSE-RF2, ESSE-RF3, conducted in 2012-2022, demonstrate reserves for reducing the risk of adverse events in the Russian population at all stages of the HTN control cascade. The HTN control cascade is defined based on epidemiological data and includes following patients: individuals with HTN but unaware of it; individuals with HTN who are aware of diagnosis but not taking antihypertensive medications (AHMs); patients with HTN taking AHMs but not achieving blood pressure (BP) control; patients with controlled HTN. In total, there are currently 30,4 million individuals with HTN in the Russian Federation aged 34-64 years who are unaware of their disease, are not taking AHMs, or are not achieving target BP levels. This represents the most significant potential for reducing mortality in the Russian Federation in the medium term. Barriers to achieving effective HTN control and approaches to reducing the population burden of HTN and improving the effectiveness of its management in the healthcare system are analyzed using literature data. To improve the effectiveness of HTN control health-promoting environment in residence and workplace (including the availability of healthy foods and opportunities for exercise) should be created. It is necessary to implement preventive counseling in individual and group formats (“Health Schools”), increase the coverage of BP measurement in the population, and improve the accuracy of office BP measurement. Measures aimed at increasing medication adherence of patients, improving the quality of health care, and reducing patient costs for medications should be implemented. This article presents a programmatic approach to improving HTN control with a set of measures for each stage of HTN cascade, including measures aimed at preventing the onset of HTN, timely detection of patients and registration for outpatient monitoring, measures to improve medication adherence and the effectiveness of HTN control. In the Russian Federation, experience in implementing federal and regional HTN programs has demonstrated the rationale of this approach. Effective HTN control is possible by combining the necessary measures within a special program, since some of these measures are outside the healthcare system. A new federal HTN program would be a justified step toward increasing the active life expectancy of the Russian population.