Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Abstract

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. MethodsWe used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including

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“…Hypertension is an important risk factor for cardiovascular diseases and a serious global problem. The prevalence of hypertension has doubled in the past three decades, accounting for 8.5 million deaths annually worldwide ( 26 , 27 ). More importantly, Hypertension was the most common comorbidity among patients with cancer in a large observational cohort study, with a reported prevalence of 38% ( 28 ).…”

Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data

“…Although we expect this impact on our study findings, if any, to be minimal as the size of the AMA is relatively small, and primary care, which is the level at which hypertension is often diagnosed and managed, is spread throughout the city [ 60 ]. As a result, household and individual socioeconomic factors, which were included in our model, are likely to have bigger influence on access to care and treatment, which remain much lower in SSA than in other regions [ 6 , 61 , 62 ]. Furthermore, we did not have robust information on typical or long-term dietary features, which are known determinants of BMI and BP [ 17 , 32 ].…”

“…Elevated blood pressure (BP) and body-mass index (BMI) are important risk factors for noncommunicable diseases (NCDs), such as cardiovascular diseases (CVDs), diabetes, kidney disease, and dementia [ 1 , 2 ], and responsible for substantial burden of NCDs [ 3 ]. While high-income countries have experienced declines in population levels of BP and hypertension over the years, BP and hypertension in sub-Saharan Africa (SSA), the fastest urbanising region of the world [ 4 ], is currently rising and at levels surpassing high-income countries [ 5 , 6 ]. BMI is similarly rising in SSA, particularly among women [ 7 , 8 ].…”

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“…Hypertension is one of the most common diseases significantly increasing the risk of cardiovascular disease and chronic kidney disease (CKD). The prevalence of hypertension among adults has increased from 650 million to 1.28 billion in the last 30 years, with 41% of female and 51% of male patients with hypertension being undiagnosed [1]. Moreover, only 23% of female and 18% of male patients with hypertension have well-controlled blood pressure (BP) [1].…”

“…The prevalence of hypertension among adults has increased from 650 million to 1.28 billion in the last 30 years, with 41% of female and 51% of male patients with hypertension being undiagnosed [1]. Moreover, only 23% of female and 18% of male patients with hypertension have well-controlled blood pressure (BP) [1]. Although hypertension is easily diagnosed via BP measurement and treated with various drugs at a low cost, many patients continue to have poorly controlled hypertension.…”