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Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries
Open accessAbstract
Background: Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010. Methods: We searched MEDLINE from 1995 through 2014 and supplemented with manual searches of retrieved article references. We included 135 population-based studies of 968 419 adults from 90 countries. Sex- and age-specific hypertension prevalences from each country were applied to population data to calculate regional and global numbers of hypertensive adults. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: In 2010, 31.1% (95% confidence interval, 30.0%–32.2%) of the world’s adults had hypertension; 28.5% (27.3%–29.7%) in high-income countries and 31.5% (30.2%–32.9%) in low- and middle-income countries. An estimated 1.39 (1.34–1.44) billion people had hypertension in 2010: 349 (337–361) million in high-income countries and 1.04 (0.99–1.09) billion in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries. During the same period, the proportions of awareness (58.2% versus 67.0%), treatment (44.5% versus 55.6%), and control (17.9% versus 28.4%) increased substantially in high-income countries, whereas awareness (32.3% versus 37.9%) and treatment (24.9% versus 29.0%) increased less, and control (8.4% versus 7.7%) even slightly decreased in low- and middle-income countries. Conclusions: Global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
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“Despite several initiatives, the prevalence of raised BP and adverse impact on cardiovascular morbidity and mortality are increasing globally, irrespective of income. 4,5”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [4]
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“When reviewing global figures, an estimated 1.39 billion people had hypertension in 2010. 4”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [4]
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“The large disparities in the regional burden of hypertension are accompanied by low levels of awareness, treatment and control rates in LMIC, when compared to HIC.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [4]
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“with an estimated 349 million with hypertension in HIC and 1.04 billion in LMICs. 4”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [4]
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“In response to poor global awareness for hypertension (estimated 67% in HIC and 38% in LMIC), 4”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [4]
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“good BP control was only achieved in less than one-third and one-tenth of patients with hypertension in highincome and lower-income countries, respectively. 4”
In the citing paper
“About 1/4th of adults have high blood pressure”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [1]
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“Between 1.13 and 1.4 billion people had hypertension in 2010 (defined as >140/90 mm Hg.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [1]
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“Worldwide, about half of adults with hypertension are unaware that their blood pressure is high, a situation more dire in low-income countries.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [1]
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“Two-thirds of those living with hypertension are in low- and middle-income countries where most of the world's population lives”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [1]
In the citing paper
“In high-income countries, the average rates of awareness, treatment, and control are 67%, 55.6%, and 28.4%, respectively, while in low- to middle-income countries the rates are 37.9%, 29%, and 7.7%, respectively.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [1]
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Reprint of: Prevention and Control of Hypertension
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Pengpid, S., Vonglokham, M., Kounnavong, S., Sychareun, V., & Peltzer, K. (2019) · Vascular Health and Risk Management · doi:10.2147/vhrm.s199178 · Cited by 39
Shetty, A. K., Upadhya, R., Madhu, L. N., & Kodali, M. (2019) · Aging and Disease · doi:10.14336/ad.2019.0330 · Cited by 38
Lee, M., Lee, W. H., Park, G.-S., Lim, H., & Kim, J. (2019) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.19-27652 · Cited by 39
Zhang, X., Zheng, Y., Chen, Q., Zhao, Y., & Zang, X. (2019) · Psychology Health & Medicine · doi:10.1080/13548506.2019.1687919 · Cited by 42
Endocrine Causes of Hypertension
de Silva, T., Cosentino, G., Ganji, S. S., Riera-Gonzalez, A., & Hsia, D. S. (2020) · Current Hypertension Reports · doi:10.1007/s11906-020-01108-3 · Cited by 39
Pediatric hypertension: an updated review
Ashraf, M., Irshad, M., & Parry, N. A. (2020) · Clinical Hypertension · doi:10.1186/s40885-020-00156-w · Cited by 42
Heidari, Z., Fard, N. R. P., Clark, C. C. T., & Haghighatdoost, F. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.02.033 · Cited by 41
Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial
Brady, T., Charleston, J., Ishigami, J., Miller, E., Matsushita, K., & Appel, L. (2021) · HYPERTENSION · doi:10.1161/hypertensionaha.121.17496 · Cited by 29
Lee, E. K., Poon, P., Yu, C., Lee, V. W., Chung, V. C., & Wong, S. Y. (2022) · The Journal of Clinical Hypertension · doi:10.1111/jch.14482 · Cited by 38
Association Between Serum Calcium and the Prevalence of Hypertension Among US Adults
Yang, H., Liu, H., Sun, J.-Y., Kong, X., Sun, W. Y., & Xiong, Y. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.719165 · Cited by 40
Chen, M., Zhang, X., Liu, Y.-M., Chen, Z., Li, H., Lei, F., Qin, J., Ji, Y., Zhang, P., Cai, J., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.754778 · Cited by 38
The immunomodulatory effects of antihypertensive therapy: A review
Felkle, D., Jarczyński, M., Kaleta, K., Zięba, K., & Nazimek, K. (2022) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2022.113287 · Cited by 40
Prevalence of Chronic Kidney Disease Among US Adults With Hypertension, 1999 to 2018
Zeng, X., Zeng, Q., Zhou, L., Zhu, H., & Luo, J. (2023) · Hypertension · doi:10.1161/hypertensionaha.123.21482 · Cited by 38
Song, S., Cai, X., Hu, J., Zhu, Q., Shen, D., Ma, H., Zhang, Y., Ma, R., Zhou, P., Yang, W., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1424207 · Cited by 38
Cuschieri, S., Vassallo, J., Calleja, N., Pace, N. P., & Mamo, J. A. (2017) · International Journal of Hypertension · doi:10.1155/2017/7107385 · Cited by 41
“The male gender, in our study, exhibited the highest hypertension prevalence, which is consistent with what is normally found within high-income countries [13].”
Urinary Exosomes and Their Cargo: Potential Biomarkers for Mineralocorticoid Arterial Hypertension?
Barros, E., & Carvajal, C. A. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00230 · Cited by 40
Tan, C. S., Hassali, M. A., Neoh, C. F., & Saleem, F. (2017) · Pharmacy Practice · doi:10.18549/pharmpract.2017.04.1074 · Cited by 38
Jaffe, M. G., Frieden, T. R., Campbell, N. R. C., Matsushita, K., Appel, L. J., Lackland, D. T., Zhang, X. H., Muruganathan, A., & Whelton, P. K. (2018) · Journal of Clinical Hypertension · doi:10.1111/jch.13280 · Cited by 39
Mutemwa, M., Peer, N., de Villiers, A., Mukasa, B., Matsha, T. E., Mills, E. J., & Kengne, A. P. (2018) · Medicine · doi:10.1097/md.0000000000012121 · Cited by 38
“At the global level, treatment rate of hypertension among aware hypertensive individuals has been estimated at 56%.([19]) The driver of the high treatment rate in our study is likely the free access to BP control medications in the public health system in South Africa, which is not the case in most other countries in…”
BackgroundLin, X., Wang, X., Li, X., Song, L., Meng, Z., Yang, Q., Zhang, W., Gao, Y., Yang, Z., Cai, H., et al. (2019) · International Journal of Endocrinology · doi:10.1155/2019/7545137 · Cited by 38
Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries
Zack, R. M., Okunade, O., Olson, E. M., Salt, M. J., Amodeo, C., Anchala, R., Berwanger, O. B., Campbell, N. R. C., Chia, Y. C., Damasceno, A. A. M., et al. (2019) · Hypertension · doi:10.1161/hypertensionaha.118.11916 · Cited by 38
Afsargharehbagh, R., Rezaie-Keikhaie, K., Rafiemanesh, H., Balouchi, A., Bouya, S., & Dehghan, B. (2019) · Current Hypertension Reports · doi:10.1007/s11906-019-0933-z · Cited by 40
Rahimi, K., Canoy, D., Nazarzadeh, M., Salimi‐Khorshidi, G., Woodward, M., Teo, K. K., Davis, B. R., Chalmers, J. P., & Pepine, C. J. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028698 · Cited by 38
Paniagua-Ávila, A., Fort, M. P., Glasgow, R. E., Gulayin, P., Hernández-Galdamez, D. R., Mansilla, K., Palacios, E., Peralta-García, A., Roche, D., Rubinstein, A., et al. (2020) · Trials · doi:10.1186/s13063-020-04345-8 · Cited by 39
Self-citationAssociation of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial
Mayl, J. J., German, C. A., Bertoni, A. G., Upadhya, B., Bhave, P. D., Yeboah, J., & Singleton, M. J. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.017334 · Cited by 40
Ultraprocessed beverages and processed meats increase the incidence of hypertension in Mexican women
Monge, A., Canella, D. S., López‐Olmedo, N., Lajous, M., Cortés-Valencia, A., & Stern, D. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520004432 · Cited by 42
Nonadherence to antihypertensive medications amongst patients with uncontrolled hypertension
Kulkarni, S., Rao, R., Goodman, J., Connolly, K., & O’Shaughnessy, K. M. (2021) · Medicine · doi:10.1097/md.0000000000024654 · Cited by 38
“39 billion.([1]) This figure continues to rise, explained partly by increasing prevalence in low- and middleincome countries.”
BackgroundThe role of smoking cessation programs in lowering blood pressure: A retrospective cohort study
Tsai, S.-Y., Huang, W.-H., Chan, H.-L., & Hwang, L. (2021) · Tobacco Induced Diseases · doi:10.18332/tid/142664 · Cited by 40
Metadata
- Authors
- Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J.
- Affiliations
- Tulane University (US)
- ORCID
- Venue
- Circulation
- Published
- 2016-08-09
- Volume
- 134
- Issue
- 6
- Pages
- 441-450
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4979614
- OpenAlex
- W2504981678
- Cited by
- 3,531
- References
- 39
- Citations by year
- 2026: 248 · 2025: 362 · 2024: 410 · 2023: 432 · 2022: 468 · 2021: 549 · 2020: 401 · 2019: 331 · 2018: 203 · 2017: 113 · 2016: 10
- FWCI
- 180.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- World Health Organization
- National Heart, Lung, and Blood Institute (U01HL114197, T32HL007024)
- National Institute of General Medical Sciences (P20GM109036)
- Fogarty International Center (D43TW009107)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- hypertension, global health disparities, hypertension prevalence, hypertension awareness, antihypertensive therapy, blood pressure control, low- and middle-income countries, high-income countries, secular trends, global burden of disease
- MeSH terms
- Cross-Sectional Studies, Developing Countries, Humans, Hypertension, Population Surveillance, Global Health, Prevalence, Developed Countries, Healthcare Disparities
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