Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents

Abstract

Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%–86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%–66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%–74.1%) and 38.6% (10.1%–55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%–71.9%) and 45.6% (18.6%–64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%–56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%–30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.

Blood Pressure Control and Cardiovascular Outcomes: Real-world Implications of the 2017 ACC/AHA Hypertension Guideline

“…Second, BPs were measured during a single visit both in the KNHANES and the cohort. Repeated visits or ambulatory measurements have been shown to minimize the chance of misclassifications 30 . The 2017 ACC/AHA guideline also stresses the role of out-of-office and self-monitored BP measurements 10 .…”

Monitoring and evaluation framework for hypertension programs. A collaboration between the Pan American Health Organization and World Hypertension League

“…Hypertension is preventable, and its treatment is effective in reducing blood‐pressure‐related diseases, and in most settings, is very cost‐effective and can be cost‐saving . However, despite many efforts and resources invested, in most populations hypertension control rates are low . Fortunately, increasing attention is being directed towards hypertension control by global, national, and regional governmental and non‐governmental organizations …”

An Update on Masked Hypertension

“…A recent analysis by Melgarejo et al demonstrated that the prevalence of masked hypertension also varies by geographic region. (15) Examining ABPM data from 10 cohorts over 3 continents, the authors found that the prevalence of masked hypertension defined using the daytime, 24-hour, and/or nighttime periods on ABPM ranged from 8.8% in Belgium (in the Belgian Population Study) to 30.5% in China (the JingNing Population Study) among individuals with non-elevated clinic BP. Significant variation by geographic region was also observed in an analysis of the ARTEMIS registry, an international network of clinics performing ABPM, where the prevalence of masked hypertension was observed to range from 9% in Europe to 16% in Asia and 17% in Africa with masked hypertension defined using 24-hour ABPM.…”