Published in the British medical journal, The Lancet, on Thursday, the study, which took five years and involved nearly 500 researchers from 50 countries, including India, found that globally high BP jumped four spots since 1990 to become the worst risk factor for disease, followed by smoking including second-hand smoke, alcohol, low fruit consumption and high body fat.
However for Indians, high BP is the third worst threat after IAP and smoking, including second-hand smoke.
The World Health Organization (WHO) had said that IAP was claiming 500,000 lives in India every year, most of whom were women and children. According to WHO, India accounted for 80% of the 600,000 premature deaths that occur in south-east Asia annually due to exposure to IAP. Nearly 70% of rural households in India don't even have ventilation.
More than three billion people rely on the burning of solid fuels to prepare their meals. Burning solid fuels emits carbon monoxide, particulates, benzene and formaldehyde which can result in pneumonia, asthma, blindness, lung cancer, tuberculosis and low birth weight.
WHO estimates that pollution levels in rural Indian kitchens are 30 times higher than recommended levels and six times higher than air pollution levels found in the national Capital.
Speaking to TOI from London, the study's lead author professor Majid Ezzati of the Imperial College, London, said, " South Asia, where India makes up the largest share of population, really shows the global risk factor transition. The leading risks are both those associated with poverty, such as under-nutrition and not having clean fuels, and those that largely affect chronic disease like high blood pressure and smoking. This mix is unique among regions."
He added, "Aggressive actions against smoking and other forms of tobacco use, actions that reduce blood pressure, mass media campaigns to encourage lower use of salt, or improving primary care for diagnosing and treating high blood pressure besides preventing the rise in overweight and diabetes will greatly help India."
According to Prof Ezzati, with India economically developing, "gas and kerosene for cooking is more affordable. What India needs to look into is how to make it available in rural India. Checking for high BP has to be made mandatory across primary health centers and medication against high BP must be encouraged besides lifestyle changes. Generic drugs manufactured by Indian companies itself are very cheap."
Dr Ezzati finds it a strange dichotomy that while majority of Indians are vegetarians, the intake of fruit is very low.
Sharing the top 10 threats for Asia, mainly India, Prof Ezzati said they include high childhood underweight, diet low in fruits, high blood glucose levels, alcohol use, iron deficiency, sub-optimal breast feeding, low physical activity and occupational injuries.

According to the study, in 2010, globally the two most important risk factors were high BP — estimated to be responsible for 9.4 million deaths — and tobacco smoking (accounted for 6.3 million deaths).

Alcohol use was the third most important risk factor that believed to have claimed 5 million deaths.
Collectively, dietary factors and physical inactivity were responsible for 12.5 million deaths with the most prominent dietary risks found to be diets low in fruit and diets high in sodium).
Strikingly, childhood underweight, which was ranked as the most important contributor to global disease burden in 1990 and responsible for 2.3 million deaths in that year, dropped to eighth place in 2010, and was estimated to have caused 86,0000 mortalities.
In 1990, the second ranked risk factor was household air pollution from solid fuel use — responsible for 4.4 million deaths in 1990 — and although this had dropped to fourth place in 2010, it was still responsible for 3.5 million mortalities.
High body-mass index caused 3.4 million deaths, high fasting plasma glucose caused another 3·4 million, high total cholesterol caused 2 million fatalities and low bone mineral density caused 0.2 million mortalities.
Of the individual dietary risk factors, the largest attributable burden in 2010 was associated with diets low in fruits (4.9 million deaths) followed by diets high in sodium (4 million deaths), low in nuts and seeds (2.5 million), low in whole grains (1.7 million), low in vegetables (1.8 million) and low in seafood omega-3 fatty acids (1.4 million deaths).
The burdens of disease attributable to tobacco smoking including second-hand smoke were 6.3 million deaths.
Occupational risk factors accounted for 0.9 million deaths followed by sexual abuse and violence (0.2 million deaths), unimproved water and sanitation (0.3 million deaths)
With the exception of house hold air pollution, which is a significant contributor to childhood lower respiratory tract infections, the five leading risk factors in 2010 (high blood pressure, tobacco smoking including secondhand smoke, alcohol use, household air pollution, and diets low in fruits) are mainly causes of adult chronic disease, especially cardio vascular ailments and cancers.
Child and maternal under-nutrition was responsible for the next largest attributable burden of the risk factor clusters (1.4 million deaths) with childhood underweight the largest individual contributor (0.9 million), followed by iron deficiency (0.1 million) and suboptimal breast feeding (0.5 million).