TY - JOUR
T1 - Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019
T2 - a pooled analysis of 1201 population-representative studies with 104 million participants
AU - NCD Risk Factor Collaboration (NCD-RisC)
AU - Zhou, Bin
AU - Carrillo-Larco, Rodrigo M.
AU - Danaei, Goodarz
AU - Riley, Leanne M.
AU - Paciorek, Christopher J.
AU - Stevens, Gretchen A.
AU - Gregg, Edward W.
AU - Bennett, James E.
AU - Solomon, Bethlehem
AU - Singleton, Rosie K.
AU - Sophiea, Marisa K.
AU - Iurilli, Maria L.C.
AU - Lhoste, Victor P.F.
AU - Cowan, Melanie J.
AU - Savin, Stefan
AU - Woodward, Mark
AU - Balanova, Yulia
AU - Cifkova, Renata
AU - Damasceno, Albertino
AU - Elliott, Paul
AU - Farzadfar, Farshad
AU - He, Jiang
AU - Ikeda, Nayu
AU - Kengne, Andre P.
AU - Khang, Young Ho
AU - Kim, Hyeon Chang
AU - Laxmaiah, Avula
AU - Lin, Hsien Ho
AU - Maira, Paula Margozzini
AU - Miranda, J. Jaime
AU - Neuhauser, Hannelore
AU - Sundström, Johan
AU - Varghese, Cherian
AU - Widyahening, Indah S.
AU - Zdrojewski, Tomasz
AU - Ezzati, Majid
AU - Abarca-Gómez, Leandra
AU - Abdeen, Ziad A.
AU - Abdul Rahim, Hanan F.
AU - Abu-Rmeileh, Niveen M.
AU - Acosta-Cazares, Benjamin
AU - Adams, Robert J.
AU - Aekplakorn, Wichai
AU - Afsana, Kaosar
AU - Afzal, Shoaib
AU - Agdeppa, Imelda A.
AU - Aghazadeh-Attari, Javad
AU - Aguilar-Salinas, Carlos A.
AU - Agyemang, Charles
AU - Ahmad, Noor Ani
AU - Ahmadi, Ali
AU - Ahmadi, Naser
AU - Ahmadi, Nastaran
AU - Ahmadizar, Fariba
AU - Ahmed, Soheir H.
AU - Ahrens, Wolfgang
AU - Ajlouni, Kamel
AU - Al-Raddadi, Rajaa
AU - Alarouj, Monira
AU - AlBuhairan, Fadia
AU - AlDhukair, Shahla
AU - Ali, Mohamed M.
AU - Alkandari, Abdullah
AU - Alkerwi, Ala’a
AU - Allin, Kristine
AU - Aly, Eman
AU - Amarapurkar, Deepak N.
AU - Amougou, Norbert
AU - Amouyel, Philippe
AU - Andersen, Lars Bo
AU - Anderssen, Sigmund A.
AU - Anjana, Ranjit Mohan
AU - Ansari-Moghaddam, Alireza
AU - Ansong, Daniel
AU - Aounallah-Skhiri, Hajer
AU - Araújo, Joana
AU - Ariansen, Inger
AU - Aris, Tahir
AU - Arku, Raphael E.
AU - Arlappa, Nimmathota
AU - Aryal, Krishna K.
AU - Aspelund, Thor
AU - Assah, Felix K.
AU - Assunção, Maria Cecília F.
AU - Auvinen, Juha
AU - Avdićová, Mária
AU - Azevedo, Ana
AU - Azimi-Nezhad, Mohsen
AU - Azizi, Fereidoun
AU - Azmin, Mehrdad
AU - Babu, Bontha V.
AU - Bahijri, Suhad
AU - Balakrishna, Nagalla
AU - Bamoshmoosh, Mohamed
AU - Banach, Maciej
AU - Banadinović, Maja
AU - Bandosz, Piotr
AU - Banegas, José R.
AU - Baran, Joanna
AU - Barbagallo, Carlo M.
AU - Barceló, Alberto
AU - Barkat, Amina
AU - Barreto, Marta
AU - Barros, Aluisio J.D.
AU - Barros, Mauro Virgílio Gomes
AU - Bartosiewicz, Anna
AU - Basit, Abdul
AU - Bastos, Joao Luiz D.
AU - Bata, Iqbal
AU - Batieha, Anwar M.
AU - Batyrbek, Assembekov
AU - Baur, Louise A.
AU - Beaglehole, Robert
AU - Belavendra, Antonisamy
AU - Romdhane, Habiba Ben
AU - Benet, Mikhail
AU - Benson, Lowell S.
AU - Berkinbayev, Salim
AU - Bernabe-Ortiz, Antonio
AU - Bernotiene, Gailute
AU - Bettiol, Heloísa
AU - Bezerra, Jorge
AU - Bhagyalaxmi, Aroor
AU - Bhargava, Santosh K.
AU - Bia, Daniel
AU - Biasch, Katia
AU - Lele, Elysée Claude Bika
AU - Bikbov, Mukharram M.
AU - Bista, Bihungum
AU - Bjerregaard, Peter
AU - Bjertness, Espen
AU - Bjertness, Marius B.
AU - Björkelund, Cecilia
AU - Bloch, Katia V.
AU - Blokstra, Anneke
AU - Bo, Simona
AU - Bobak, Martin
AU - Boeing, Heiner
AU - Boggia, Jose G.
AU - Boissonnet, Carlos P.
AU - Bojesen, Stig E.
AU - Bongard, Vanina
AU - Bonilla-Vargas, Alice
AU - Braeckman, Lutgart
AU - Bruno, Graziella
AU - Bueno-De-Mesquita, H. Bas
AU - Burns, Con
AU - Cardoso, Viviane C.
AU - Cervantes-Loaiza, Marvin
AU - Chadjigeorgiou, Charalambos A.
AU - Chamukuttan, Snehalatha
AU - Chan, Angelique W.
AU - Chan, Queenie
AU - Chaturvedi, Himanshu K.
AU - Chaturvedi, Nish
AU - Chee, Miao Li
AU - Chen, Chien Jen
AU - Chen, Fangfang
AU - Chen, Huashuai
AU - Chen, Shuohua
AU - Chen, Zhengming
AU - Cheng, Ching Yu
AU - Cheraghian, Bahman
AU - Dekkaki, Imane Cherkaoui
AU - Chetrit, Angela
AU - Chien, Kuo Liong
AU - Chiolero, Arnaud
AU - Chiou, Shu Ti
AU - Chirita-Emandi, Adela
AU - Chirlaque, María Dolores
AU - Cho, Belong
AU - Christensen, Kaare
AU - Christofaro, Diego G.
AU - Chudek, Jerzy
AU - Cinteza, Eliza
AU - Claessens, Frank
AU - Clarke, Janine
AU - Clays, Els
AU - Cohen, Emmanuel
AU - Concin, Hans
AU - Cooper, Cyrus
AU - Coppinger, Tara C.
AU - Costanzo, Simona
AU - Cottel, Dominique
AU - Cowell, Chris
AU - Craig, Cora L.
AU - Crampin, Amelia C.
AU - Crujeiras, Ana B.
AU - Cruz, Juan J.
AU - Csilla, Semánová
AU - Cui, Liufu
AU - Cureau, Felipe V.
AU - Cuschieri, Sarah
AU - D’Arrigo, Graziella
AU - d’Orsi, Eleonora
AU - Dallongeville, Jean
AU - Dankner, Rachel
AU - Dantoft, Thomas M.
AU - Dauchet, Luc
AU - Davletov, Kairat
AU - De Backer, Guy
AU - De Bacquer, Dirk
AU - De Curtis, Amalia
AU - de Gaetano, Giovanni
AU - De Henauw, Stefaan
AU - de Oliveira, Paula Duarte
AU - De Ridder, David
AU - De Smedt, Delphine
AU - Deepa, Mohan
AU - Deev, Alexander D.
AU - DeGennaro, Vincent
AU - Delisle, Hélène
AU - Demarest, Stefaan
AU - Dennison, Elaine
AU - Deschamps, Valérie
AU - Dhimal, Meghnath
AU - Di Castelnuovo, Augusto F.
AU - Dias-Da-Costa, Juvenal Soares
AU - Diaz, Alejandro
AU - Dickerson, Ty T.
AU - Dika, Zivka
AU - Djalalinia, Shirin
AU - Do, Ha T.P.
AU - Dobson, Annette J.
AU - Donfrancesco, Chiara
AU - Donoso, Silvana P.
AU - Döring, Angela
AU - Dorobantu, Maria
AU - Dörr, Marcus
AU - Doua, Kouamelan
AU - Dragano, Nico
AU - Drygas, Wojciech
AU - Duante, Charmaine A.
AU - Duboz, Priscilla
AU - Duda, Rosemary B.
AU - Dulskiene, Virginija
AU - Dushpanova, Anar
AU - Džakula, Aleksandar
AU - Dzerve, Vilnis
AU - Dziankowska-Zaborszczyk, Elzbieta
AU - Eddie, Ricky
AU - Hayes, Alison J.
AU - Hobbs, Michael
AU - Jamrozik, Konrad
AU - Le, Tuyen D.
AU - Menon, Geetha R.
AU - Nguyen, Quang V
AU - Nguyen, Quang Ngoc
AU - Taylor, Anne
AU - Yang, Yang
N1 - Funding Information:
This study was funded by WHO. BZ is supported by a fellowship from the Abdul Latif Jameel Institute for Disease and Emergency Analytics, funded by a donation from Community Jameel, at Imperial College London, London, UK. ME is supported by the British Heart Foundation (Centre of Research Excellence grant RE/18/4/34215).
Funding Information:
RC reports grants from the Ministry of Health of the Czech Republic; and personal fees from Herbacos Recordati, Amegen, and Krka, outside the submitted work. GD reports consulting fees from Vital Strategies; and an honorarium from the American College of Cardiology, outside the submitted work. ME reports a charitable grant from the AstraZeneca Young Health Programme; and personal fees from Prudential, outside the submitted work. CJP reports holding stocks in Pfizer, outside the submitted work. JS reports ownership in companies providing services to Itrim, Amgen, Janssen, Novo Nordisk, Eli Lily, Boehringer Ingelheim, Bayer, Pfizer, and AstraZeneca, outside the submitted work. MW reports personal fees from Amgen, Kyowa Kirin and Freeline, outside the submitted work. All other authors declare no competing interests.
Publisher Copyright:
© 2021 World Health Organization
PY - 2021/9/11
Y1 - 2021/9/11
N2 - 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. Methods: We 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 Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding: WHO.
AB - 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. Methods: We 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 Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding: WHO.
UR - http://www.scopus.com/inward/record.url?scp=85114679906&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(21)01330-1
DO - 10.1016/S0140-6736(21)01330-1
M3 - Article
C2 - 34450083
AN - SCOPUS:85114679906
SN - 0140-6736
VL - 398
SP - 957
EP - 980
JO - The Lancet
JF - The Lancet
IS - 10304
ER -