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The global epidemiology of hypertension

Abstract

Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Owing to the widespread use of antihypertensive medications, global mean blood pressure (BP) has remained constant or has decreased slightly over the past four decades. By contrast, the prevalence of hypertension has increased, especially in low- and middle-income countries (LMICs). Estimates suggest that 31.1% of adults (1.39 billion) worldwide had hypertension in 2010. The prevalence of hypertension among adults was higher in LMICs (31.5%, 1.04 billion people) than in high-income countries (28.5%, 349 million people). Variations in the levels of risk factors for hypertension, such as high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, may explain some of the regional heterogeneity in hypertension prevalence. Despite the increasing prevalence, the proportions of hypertension awareness, treatment and BP control are low, particularly in LMICs, and few comprehensive assessments of the economic impact of hypertension exist. Future studies are warranted to test implementation strategies for hypertension prevention and control, especially in low-income populations, and to accurately assess the prevalence and financial burden of hypertension worldwide.

Key points

  • Hypertension is the leading modifiable risk factor for cardiovascular disease and premature death worldwide.

  • The prevalence and absolute burden of hypertension is rising globally, especially in low- and middle-income countries (LMICs).

  • Awareness, treatment and control of hypertension are unacceptably low worldwide, particularly in LMICs.

  • Reductions in risk factors, including high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity and unhealthy diet, are recommended for the prevention and control of hypertension.

  • Multifaceted implementation strategies for hypertension prevention and control are needed to address barriers at the patient, provider, system and community levels.

  • Comprehensive assessments are needed to evaluate the economic impact of hypertension worldwide.

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Fig. 1: Changes in mean estimated blood pressure by world region between 1975 and 2015.
Fig. 2: Hypertension prevalence by world region in 2010.
Fig. 3: Causes of deaths worldwide attributed to increased blood pressure in 2015.

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Acknowledgements

The authors’ work is supported by the National Institute of General Medical Sciences of the National Institutes of Health (NIH) under Award Number P20GM109036 and by the National Heart, Lung, and Blood Institute of NIH under Award Number R01HL133790. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Glossary

Pooled analyses

Meta-analyses in which investigators have access to and analyse the original individual level data from the participating studies.

Regression dilution

In an epidemiological study, regression dilution refers to underestimation of the regression slope between a response and predictor variable when the predictor variable is measured imprecisely.

Network meta-analysis

A type of meta-analysis in which multiple treatments are compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator.

Crossover design

A type of clinical trial in which each participant is randomly assigned to a sequence of two or more treatments; the participant can, therefore, be used as his or her own control.

Dietary Approaches to Stop Hypertension diet

(DASH diet). A diet that emphasizes fruits, vegetables and low-fat dairy foods (including whole grains, poultry, fish and nuts) and limits red meat, sweets and sugar-containing beverages.

Weighted mean

A type of mean in which some data points contribute more to the final average than others.

Dose–response relationship

A relationship in which a change in amount, intensity or duration of an exposure is associated with either an increase or a decrease in risk of the outcome.

Convenience samples

A type of non-probability sample in which the study participants are taken from a group of people who are easy to contact or reach.

Quality-adjusted life year

(QALY). A measure of the burden of disease on a defined population that equals the sum of years of life lost (YLLs) and years lived with disability (YLDs). One DALY equals one lost year of healthy life.

Incremental cost-effectiveness ratio

(ICER). A measure of the cost-effectiveness of new health-care interventions defined as the ratio of the difference in cost between two possible interventions divided by the difference in their effect.

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Mills, K.T., Stefanescu, A. & He, J. The global epidemiology of hypertension. Nat Rev Nephrol 16, 223–237 (2020). https://doi.org/10.1038/s41581-019-0244-2

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