Taming the World’s Leading Killer

An article was published this week that has findings which could save millions of lives. Why did you miss it? Because there was zero media coverage of it. Zero! Tells you something. Tells you a lot, actually. So, here are the details. 1/thread
High blood pressure is the world’s leading killer – and will kill more people, including more young people, than COVID-19 this year. It can be prevented (mostly by lowering sodium) & treated, but, globally, only 1 in 10 people with high blood pressure have it controlled. 2/
Elegant studies by @SarahLewington2 prove for every 20-point increase in blood pressure, the death rate from cardiovascular disease DOUBLES. What’s more, this starts at a blood pressure of 115/75 – way below the usual level at which we treat, or toward which we aim treatment. 3/
But lower is better didn’t prove LOWERING more is better. That’s where the incredibly important SPRINT trial comes in. It’s one thing to prove (as Lewington did) that lower BP correlates with lower risk of death, quite another to prove that lowering BP more saves lives. 4/
Lower blood pressure reduces death risk, but how low do we need to go? That’s what’s big news about the seminal SPRINT trial just released, which proves lower is better – setting a blood pressure goal that is lower than the standard treatment goal prevented many more deaths. 5/
The SPRINT trial also showed that, despite more side effects, intensive blood pressure treatment to reach the lower blood pressure goal is safe – even in older people. Intensive treatment prevented more heart attacks, strokes and deaths. bit.ly/3u6QT2r 6/
Based on the SPRINT trial, many guidelines now recommend that certain high-risk patients with high blood pressure aim for a systolic blood pressure below 130 rather than the standard target of 140. (SPRINT aimed for <120/80.) 7/
But the bigger implication: We need to do much better getting to <140/90. For years, doctors were scared of blood pressure going too low. Now, it’s proven that “overshooting” the goal of 140/90 isn’t just something that won’t hurt the patient – it could well save their life. 8/
The death rate among people treated with a goal of <120/80 was 27% lower than the death rate of people treated to the usual target of 140/90. And for every death prevented, about 2 heart attacks are prevented, plus strokes, kidney failure, dementia, and more. 9/
We’re doing terribly on BP control globally. Terribly!!!!! 14%. Pathetic.
Why are we failing to control high blood pressure? One reason: We’ve made treatment too complicated. For the past 4 years, @ResolveTSL has learned from and with partners around the world. We summarized lessons in this article (link) and this graphic. bit.ly/3hOTDiz 11/
The @WHO HEARTS package makes hypertension treatment simple: standard treatment protocols any health worker can implement, reliable supply of quality-assured medicines, team-based care, patient-centered services, and a strong health information system. bit.ly/347PkXv 12/
Think about it. A study came out this week that could save millions of lives. Not one news article. Tho “just” final report from study previously released early (because findings are so important), shows we have a lot to learn about what to focus on to save the most lives. 13/
.@ResolveTSL partners with countries around world to implement @WHO HEARTS package to lower blood pressure. Sodium reduction and hypertension treatment can prevent 3 million early deaths – every year! Lower blood pressure can save millions of lives. Let’s make this happen. 14/end

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Dr. Tom Frieden

Dr. Tom Frieden Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @DrTomFrieden

18 May
Estimated excess mortality during the pandemic far outstripped officially reported Covid deaths in most countries. However, many countries, and in particular low- and middle- income countries, don’t estimate excess deaths econ.st/33VduV6 1/
Statistical modelling by @TheEconomist suggests the Covid death toll is between 7.1m and 12.7m. That means the official death toll represents, at best, about half the true toll and, at worst, a quarter of it. 2/
Most uncounted Covid deaths occurred in LMICs. In OECD countries, the true death toll was estimated to be 1.2 times the official number; in parts of Africa, it was estimated to be 14 times the official number. 3/
Read 4 tweets
14 May
A Tale of Two Pandemics

The pandemic won’t be over until most of the world is vaccinated, but access is a HUGE challenge.

Globally, we must scale up manufacturing and vaccinate the 50M health workers & 1B people over 60. In the US, we must proactively reach the unreached. 1/
Vaccine inequity is a serious problem, both ethically and epidemiologically. It increases the risk that dangerous variants will emerge. Wealthy countries have excess vaccines while lower and middle-income countries go without. 2/ Image
The reality is that global vaccine supply will lag the need for at least a year. Open IP is a step, but we need much more—transfer of vaccine technology and hubs for production. We can also be more strategic in use of the vaccine that is available. 3/
Read 23 tweets
13 May
The Last Pandemic?

The Covid pandemic has killed 3+ million people and driven 115M people into extreme poverty. It will cost the world $22 trillion by 2025. And it didn't have to happen.

A new report could be pivotal in efforts to prevent the next pandemic. 1/
The Independent Panel for Pandemic Preparedness and Response (@TheIndPanel) was created last year by @WHO to ensure the world is better able to address health threats such as Covid. They released a sweeping new report. nyti.ms/2RS1TTV 2/
Because the recommendations detailed in the report are so important, I’m going to highlight some of them in the hope that the story of Covid isn’t repeated. Read the report here: bit.ly/3w6nEyr 3/
Read 24 tweets
30 Apr
Globally, the end of the pandemic isn't near.

More than a million lives depend on improving our response quickly.

Don’t be blinded by the light at the end of the tunnel. There isn't enough vaccine and the virus is gathering strength & speed. Global cooperation is crucial. 1/
India’s surge is a reminder that the virus is learning about and adapting to us faster than we're learning and adapting to it. Covid, fueled by variants, is an ongoing & increasing risk. The pandemic is more severe than ever—more transmissible, more deadly, more human fatigue. 2/ Image
Dazzling scientific progress resulted in Covid vaccines that are more effective than many experts dared to hope. But although Israel, the UK, and, soon, the US will have a new reality with the virus largely tamed by vaccines, global vaccination lags badly. 3/ Image
Read 21 tweets
16 Apr
Benefits, Risks, and Future of Vaccines and the Pandemic

Our vaccine safety monitoring system works. Reports of blood clots led to quick investigation, quick action, and transparency about what is known, not known and next steps. Vaccines remain our way out of the pandemic. 1/14
Global collaboration has been critical throughout the pandemic. Public health and medical experts around the world are collaborating to determine whether the events associated with AstraZenenca vaccine are the same as these events which may be associated with the J&J shot. 2/14
Tech transfer is crucial. The pandemic is the world’s most important problem. mRNA technology is our best solution. Create high-quality manufacturing platforms and hubs around the world to improve vaccine access. mRNA technology is an insurance policy against the pandemic. 3/14
Read 14 tweets
9 Apr
The US vaccination campaign is facing a fundamental challenge: getting the vaccine where it’s needed most. Millions of Americans are still unprotected, many of them at high risk of severe illness. Our 4th surge is beginning. Lives are at stake. 1 of thread/
1 in 3 people in the US have gotten at least one dose of vaccine—but that means 2 in 3 haven’t. Millions of people age 50-64 and 65+ who haven’t yet been vaccinated can still get Covid and are at much higher risk of severe illness or death, especially with the new variants. 2/
Some states are doing much better than others reaching older people: NH, VT, ME, RI, CT, MA, SD have given >1 dose to more than 85% of residents 65+ years old. In TN, WV, MS, Alabama, HI, and PR that proportion is less than 70%. 3/
Read 18 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!