High BP is the most important cause of mortality and disease burden globally as well as in South Asian region. Global Burden of Diseases Study has reported that in year 2013 high systolic BP globally led to 10.8 million deaths and 208.1 million DALYs and in South Asian countries led to 2.1 million deaths (19.4%) and 49.9 million DALYs (24.0%). Global Burden of Chronic Disease Risk Factors study has reported from years 1980 to 2008 that while mean BP declined in high income countries, it increased in South Asian countries. Globally the mortality from BP from 1990 to 2013 has increased by 49.1% and age-adjusted population attributable fraction (PAF) by 8.8%, the DALYs have increased by 45.1% and PAF by 14.1%. The increase is much more in South Asian region.
A number of epidemiological studies have reported that hypertension is increasing in India, Pakistan and Bangladesh. There are only a few studies from Nepal and other countries. All these studies have reported lower hypertension in rural South Asian populations. Studies in India have reported an urban-rural convergence in hypertension prevalence. In the last 15 years, among the urban Indian adults prevalence of hypertension has increased from 25–28% to 30–32% in rural populations the increase has been from 15–20% to 25–30% presently.
Prevalence of uncontrolled hypertension is high in this region and varies from 70–80% in urban and 85–95% in rural populations. This is associated with low hypertension awareness and treatment. Macrolevel barriers to BP control in these countries include political apathy, bureaucratic inertia, weak health systems, overburdened healthcare providers and disempowered patients. Hypertension control can be improved in South Asian countries by better political focus on social determinants of health, development of health systems, proper healthcare financing, free or low-cost BP medicines, healthcare provider education, free primary care, task sharing with trained community health workers, patient empowerment and use of technological innovations.