Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys

Abstract

Summary Background Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in high-income countries. Methods We used data from people aged 40–79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg). Findings Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%. Interpretation Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control. Funding Wellcome Trust and WHO.

Uncontrolled and apparent treatment resistant hypertension: a cross-sectional study of Russian and Norwegian 40–69 year olds

“…16.5% in males and 34.1% in females [3]. In comparison, a study with data from 123 nationally representative surveys of 40-79 year olds in 12 high income countries [21] found that control in males ranged from 17% in Ireland to 69% in Canada. For females, from 26% in Ireland to 58% in Germany.…”

Hypertension management based on general practice care in Shanghai, China

“…These advantages of our results still exist when compared with recent survey data from other countries [16,17]. A retrospective analysis showed that the BP control rate of hypertension was 60.6% in the general practice in Italy in 2013 [18].…”

“…A retrospective analysis showed that the BP control rate of hypertension was 60.6% in the general practice in Italy in 2013 [18]. In the most recent surveys on high-income countries, their treatment rates were at most 80% and control rates were less than 70% [16]. Among them, Canada, the United States, South Korea and Germany have the highest control coverage, and they all have national hypertension education and health check-up, which is definitely important for management effect [16].…”

The Role of Oxidative Stress in Common Risk Factors and Mechanisms of Cardio-Cerebrovascular Ischemia and Depression

“…Two recent studies published in The Lancet on hypertension control in high-, middle-, and lowincome countries revealed an increasing trend of hypertension prevalence over time [53]. It is widely acknowledged that high BP is one of the most important risk factors for stroke and heart disease [54].…”