Raised blood pressure is an important modifiable risk factor for cardiovascular disease, the leading cause of death worldwide, killing 17 million people each year which represents 30% of all global deaths. Hypertension on its own currently accounts for about 7.6 million deaths worldwide and is directly responsible for 54% of all strokes and 47% of all coronary heart disease globally. Most people suffering from hypertension live in low- and middle-income countries (LMICs) which bear a disproportionately high burden of hypertension related death, almost double that of high-income countries.
Several factors contribute to the high prevalence rates of hypertension (eating of food containing too much salt and fat, overweight and obesity, harmful use of alcohol, physical inactivity, ageing, genetic factors, psychological stress, socioeconomic determinants, inadequate access to health care). Scientific studies have regularly demonstrated the health benefits of lowering blood pressure through population-wide and individual interventions.
Cost-effective strategies for lowering the hypertension prevalence include the reduction of population intake of salt/sodium, harmful use of alcohol, physical inactivity as well as overweight and obesity. High income countries have successfully begun to reduce hypertension through strong public health policies. Declining trends in blood pressure, combined with declines in smoking, body mass index and serum cholesterol possibly account for nearly half the decline in cardiovascular mortality in high income countries. However, the lack of such policies in the developing world has resulted in rising trends in blood pressure in LMICs.
In regard to LMICs in the Asia Pacific region, salt reduction promises to be a viable, highly cost-effective way to tackle rising rates in hypertension and the overall NCD burden. One of the main factors causing raised blood pressure is an excessive intake of salt/sodium which appears to be highest in south-east and central Asia, while the Western Pacific Region shows levels of consumption that greatly exceed the WHO recommendations of a reduction in salt intake to less than 5g/day (sodium 2g/day). Tremendous changes in lifestyles and dietary patterns across the region, including the availability of processed foods in both urban and rural areas of LMICs, have led to the consumption of unhealthy diets that are high in salts, fats and sugars and low in fruit and vegetables.
 To achieve a significant reduction of salt/sodium intake the main sources of sodium are to be identified in order to develop an effective strategy and set concrete targets for implementation. Moreover, data on salt/sodium intake needs to be gathered from a population-based survey.
The the so called gold standard for estimating salt intake is 24h urine collection, however other methods such as spot urine and food frequency surveys have also been used to obtain estimates at the population level. Multisectoral collaboration is required to improve the availability of products with lower sodium. The ministries of health in the Asia Pacific region need to take the initiative in establishing platforms for intersectoral collaboration and targets for reformulation of processed foods. Food-labelling regulations need to be established and caterers should be involved in reducing the amount of salt added during meal preparation. Country-specific public-awareness campaigns and community-mobilization campaigns on salt intake need to be developed and implemented. Healthcare professionals may need further training to convey the right messages and ensure effective communication
At present 33 LMICs have such a national salt reduction strategy in place due to the fact that they are not only cost-effective but also affordable and culturally acceptable to implement in any resource setting, therefore ideally suited for lower income environments and recommended by WHO as ‘best buy’ options. However, less than half the programs are implemented in LMICs which threatens the aim of an overall 30% reduction in mean population salt intake by 2025.
Since its establishment, NCDAPA has been consistently advocating for salt reduction as a means of reducing the prevalence of raised blood pressure worldwide and specifically in the Asia Pacific region. Urgent action is required at the government-level in LMICs to implement salt reduction strategies effectively. As this year’s theme of the World Hypertension Day is ‘know your numbers’, we urge everyone at an individual-level to be aware of his/her blood pressure. The number of people with undetected and uncontrolled hypertension has increased worldwide due to population growth and ageing.
Studies show that as much as one fifth of the people in high-income countries are unaware of their condition, one quarter do not receive treatment and only half actively control their blood pressure. In LMICs the situation is far worse with only half of those with hypertension aware of their condition, only a fraction receiving treatment and the majority not having their blood pressure under control. Know your numbers, as treatment is far costlier than prevention.
Join us at the World Congress of Cardiology 2016 in Mexico City 4-7 June where our Executive Director Dr. Rodrigo Rodriguez-Fernandez will be presenting the results of the first ever 24hour baseline assessment of Salt intake in Indonesia.
 Mohan, Prabhakaran: Review of Salt and Health. Technical Paper WHO South-East Asia Region, 2013.
 WHO Global Status Report on Noncommunicable Diseases 2014
 WHO Global Status Report on Noncommunicable Diseases 2014. At the 66th World Health Assembly, WHO Member States adopted the global target of a 30% reduction in mean population intake of salt/sodium by 2025.This was one of nine voluntary targets to achieve an overarching 25% reduction in premature mortality from NCDs
 Mohan, Campbell: Salt and high blood pressure, 2009; He, MacGregor: A comprehensive review on salt and health and current experience of worldwide salt reduction programmes, 2009.
 WHO Global Status Report on Noncommunicable Diseases 2014.
 Trieu K, Neal B, Hawkes C, Dunford E, Campbell N, Rodriguez-Fernandez R, et al.: Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target, 2015. Strategies and advocacy campaigns need to be specifically tailored towards each country. In Japan, where most of the sodium in the diet comes from soy sauce added during cooking, salted vegetables and miso soup, salt reduction efforts have been focused on improving people’s understanding of salt and health through public education and consumer awareness campaigns.
 WHO Global Status Report on Noncommunicable Diseases 2014.