www.thelancet.com Published online September 23, 2016 http://dx.doi.org/10.1016/S0140-6736(16)31134-5 1 The Lancet Commissions A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension Michael H Olsen*, Sonia Y Angell, Samira Asma, Pierre Boutouyrie, Dylan Burger, Julio A Chirinos, Albertino Damasceno, Christian Delles, Anne-Paule Gimenez-Roqueplo, Dagmara Hering, Patricio López-Jaramillo, Fernando Martinez, Vlado Perkovic, Ernst R Rietzschel, Giuseppe Schillaci, Aletta E Schutte, Angelo Scuteri, James E Sharman, Kristian Wachtell, Ji Guang Wang Executive summary Elevated blood pressure is the strongest modifable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. The aim of the Lancet Commission on hypertension is to identify key actions to improve the management of blood pressure both at the population and the individual level, and to generate a campaign to adopt the suggested actions at national levels to reduce the impact of elevated blood pressure globally. The frst task of the Commission is this report, which briefy reviews the available evidence for prevention, identifcation, and treatment of elevated blood pressure, hypertension, and its cardiovascular complications. The report focuses on how as-yet unsolved issues might be tackled using approaches with population-wide impact and new methods for patient evaluation and education in the broadest sense (some of which are not always strictly evidence based) to manage blood pressure worldwide. The report is built around the concept of lifetime risk applicable to the entire population from conception. Development of subclinical and sometimes clinical cardiovascular disease results from lifetime exposure to cardiovascular risk factors combined with the susceptibility of individuals to the harmful consequences of these risk factors. The Commission recognises the importance of other cardiovascular risk factors—eg, smoking, obesity, dyslipidaemia, and diabetes mellitus— on antihypertensive treatment. However, as a Commission on hypertension, this report focuses mainly on issues and actions related to elevated blood pressure. Previous action plans for improving management of elevated blood pressure and hypertension have not yet provided adequate results. Therefore, the Commission has identifed ten essential and achievable goals and ten accompanying, mutually additive, and synergistic key actions that—if implemented efectively and broadly— will make substantial contributions to the management of blood pressure globally. The Commission deliberately has not listed these complementary key actions by priority because the balance between strength of evidence, feasibility, and potential beneft could difer by country. Introduction Background Elevated blood pressure is globally the strongest modifable risk factor for cardiovascular disease and related disability. Its prevalence and downstream detrimental impact on health are increasing because of longer life expectancy and increased exposure to risk in the population. Despite extensive knowledge about ways to both prevent and treat hypertension, its global incidence, prevalence, and (more importantly) cardiovascular complications are not reduced, partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. Published Online September 23, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)31134-5 *Chair Department of Internal Medicine, Holbæk Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark (M H Olsen DMSc); Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (M H Olsen); Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, NY, USA (S Y Angell MD); Global NCD Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA (S Asma DDS); Department of Pharmacology and INSERM U 970, Georges Pompidou Hospital, Paris Descartes University, Paris, France (Prof P Boutouyrie PhD); Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada (D Burger PhD); Department of Medicine at University Hospital The mark “CDC” is owned by the US Dept of Health and Human S ervices a nd i s used w ith permission. Use of this logo is not a n endorsement by HHS or CDC or any particular product, service, or enterprise.