Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys

NCD Risk Factor Collaboration (NCD-RisC), Bin Zhou, Goodarz Danaei, Gretchen A Stevens, Honor Bixby, Cristina Taddei, Rodrigo M Carrillo-Larco, Bethlehem Solomon, Leanne M Riley, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodriguez-Martinez, Aubrianna Zhu, Kaveh Hajifathalian, Antoinette Amuzu, José R Banegas, James E Bennett, Christine Cameron, Yumi Cho, Janine Clarke, Cora L Craig, Juan J Cruz, Louise Gates, Simona Giampaoli, Edward W Gregg, Rebecca Hardy, Alison J Hayes, Nayu Ikeda, Rod T Jackson, Garry Jennings, Michel Joffres, Young-Ho Khang, Seppo Koskinen, Diana Kuh, Urho M Kujala, Tiina Laatikainen, Terho Lehtimäki, Esther Lopez-Garcia, Annamari Lundqvist, Stefania Maggi, Dianna J Magliano, Jim I Mann, Rachael M McLean, Scott B McLean, Jody C Miller, Karen Morgan, Hannelore K Neuhauser, Teemu J Niiranen, Marianna Noale, Kyungwon Oh, Luigi Palmieri, Francesco Panza, Winsome R Parnell, Markku Peltonen, Olli Raitakari, Fernando Rodríguez-Artalejo, Joel Gr Roy, Veikko Salomaa, Giselle Sarganas, Jennifer Servais, Jonathan E Shaw, Kenji Shibuya, Vincenzo Solfrizzi, Bill Stavreski, Eng Joo Tan, Maria L Turley, Diego Vanuzzo, Eira Viikari-Juntura, Deepa Weerasekera, Majid Ezzati, NCD Risk Factor Collaboration (NCD-RisC), Bin Zhou, Goodarz Danaei, Gretchen A Stevens, Honor Bixby, Cristina Taddei, Rodrigo M Carrillo-Larco, Bethlehem Solomon, Leanne M Riley, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodriguez-Martinez, Aubrianna Zhu, Kaveh Hajifathalian, Antoinette Amuzu, José R Banegas, James E Bennett, Christine Cameron, Yumi Cho, Janine Clarke, Cora L Craig, Juan J Cruz, Louise Gates, Simona Giampaoli, Edward W Gregg, Rebecca Hardy, Alison J Hayes, Nayu Ikeda, Rod T Jackson, Garry Jennings, Michel Joffres, Young-Ho Khang, Seppo Koskinen, Diana Kuh, Urho M Kujala, Tiina Laatikainen, Terho Lehtimäki, Esther Lopez-Garcia, Annamari Lundqvist, Stefania Maggi, Dianna J Magliano, Jim I Mann, Rachael M McLean, Scott B McLean, Jody C Miller, Karen Morgan, Hannelore K Neuhauser, Teemu J Niiranen, Marianna Noale, Kyungwon Oh, Luigi Palmieri, Francesco Panza, Winsome R Parnell, Markku Peltonen, Olli Raitakari, Fernando Rodríguez-Artalejo, Joel Gr Roy, Veikko Salomaa, Giselle Sarganas, Jennifer Servais, Jonathan E Shaw, Kenji Shibuya, Vincenzo Solfrizzi, Bill Stavreski, Eng Joo Tan, Maria L Turley, Diego Vanuzzo, Eira Viikari-Juntura, Deepa Weerasekera, Majid Ezzati

Abstract

Background: Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in high-income countries.

Methods: We used data from people aged 40-79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg).

Findings: Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%.

Interpretation: Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control.

Funding: Wellcome Trust and WHO.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Trends in hypertension prevalence by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.
Figure 2
Figure 2
Prevalence of hypertension and rates of awareness, treatment, and control in women and men aged 40–79 years Data are from the latest national survey in each country. Results shown are crude (ie, not age-standardised) to reflect the total burden of hypertension and its awareness, treatment, and control. Age-specific results, and their uncertainty, are available in Figure 1, Figure 3, Figure 4, Figure 5, Figure 6, and the appendix (pp 7–9). For each outcome, the colour range for cells extends from lowest to highest value. Men and women share the same colour scheme. Awareness, treatment, and control are reported as the proportions. *The latest national survey in Ireland had data for people aged 50 to 79 years; data from an earlier survey in 2007 were used for people aged 40 to 49 years. †The question on awareness was not asked in 2015 in Japan; awareness data from 2010 were used. ‡The latest national survey in Spain had data for people aged 60 to 79 years; data from an earlier survey in 2009 were used for people aged 40 to 59 years.
Figure 3
Figure 3
Trends in hypertension awareness and treatment among people with hypertension, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.
Figure 3
Figure 3
Trends in hypertension awareness and treatment among people with hypertension, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.
Figure 4
Figure 4
Age patterns of hypertension awareness, treatment, and control among women and men, according to the latest national surveys
Figure 5
Figure 5
Trends in proportion of people with hypertension who had undiagnosed or untreated stage 2 hypertension, by country, sex, and age group Error bars indicate 95% CIs.
Figure 5
Figure 5
Trends in proportion of people with hypertension who had undiagnosed or untreated stage 2 hypertension, by country, sex, and age group Error bars indicate 95% CIs.
Figure 6
Figure 6
Trends in hypertension control, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.
Figure 6
Figure 6
Trends in hypertension control, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.

References

    1. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2:634–647.
    1. Olsen MH, Angell SY, Asma S. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016;388:2665–2712.
    1. Ettehad D, Emdin CA, Kiran A. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–967.
    1. Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA. 2013;310:699–705.
    1. Padwal RS, Bienek A, McAlister FA, Campbell NR, Outcomes Research Task Force of the Canadian Hypertension Education Program Epidemiology of hypertension in Canada: an update. Can J Cardiol. 2016;32:687–694.
    1. Whelton PK, He J, Muntner P. Prevalence, awareness, treatment and control of hypertension in North America, North Africa and Asia. J Hum Hypertens. 2004;18:545–551.
    1. Antikainen RL, Moltchanov VA, Chukwuma C., Sr Trends in the prevalence, awareness, treatment and control of hypertension: the WHO MONICA Project. Eur J Cardiovasc Prev Rehabil. 2006;13:13–29.
    1. Ikeda N, Sapienza D, Guerrero R. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ. 2014;92:10–19c.
    1. Mills KT, Bundy JD, Kelly TN. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–450.
    1. Wolf-Maier K, Cooper RS, Kramer H. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43:10–17.
    1. Joffres M, Falaschetti E, Gillespie C. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3
    1. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009;27:963–975.
    1. Chow CK, Teo KK, Rangarajan S. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310:959–968.
    1. Yang F, Qian D, Hu D, Healthy Aging and Development Study Group. Data Mining Group of Biomedical Big Data Prevalence, awareness, treatment, and control of hypertension in the older population: results from the multiple national studies on ageing. J Am Soc Hypertens. 2016;10:140–148.
    1. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. National Center for Health Statistics; Hyattsville, MD: 2017. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS Data Brief, no 289.
    1. Bloch MJ. Recent data from National Health and Nutrition Examination Survey (NHANES) demonstrates no improvement in U.S. blood pressure control rates. J Am Soc Hypertens. 2018;12:3–4.
    1. Korean Society Hypertension, Hypertension Epidemiology Research Working Group. Kim HC, Cho MC. Korea hypertension fact sheet 2018. Clin Hypertens. 2018;24:13.
    1. Sala C, Santin E, Rescaldani M, Magrini F. How long shall the patient rest before clinic blood pressure measurement? Am J Hypertens. 2006;19:713–717.
    1. Myers MG, Godwin M, Dawes M. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ. 2011;342:d286.
    1. Ogedegbe G, Pickering T. Principles and techniques of blood pressure measurement. Cardiol Clin. 2010;28:571–586.
    1. Moser M. Evolution of the treatment of hypertension from the 1940s to JNC V. Am J Hypertens. 1997;10:2S–8S.
    1. Wing LM, Reid CM, Ryan P. A comparison of outcomes with angiotensin-converting—enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med. 2003;348:583–592.
    1. Gradman AH, Basile JN, Carter BL, Bakris GL, American Society of Hypertension Writing Group Combination therapy in hypertension. J Am Soc Hypertens. 2010;4:42–50.
    1. Nerenberg KA, Zarnke KB, Leung AA. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34:506–525.
    1. Seong SC, Kim YY, Khang YH. Data resource profile: the National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46:799–800.
    1. Working group set up by the Finnish Medical Society Duodecim and the Finnish Hypertension Society Current care guidelines (in Finnish)
    1. Whelton PK, Carey RM, Aronow WS. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115.
    1. Williams B, Mancia G, Spiering W. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.
    1. Shimamoto K, Ando K, Fujita T. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014) Hypertens Res. 2014;37:253–390.
    1. National Institute for Health and Clinical Excellence . Royal College of Physicians; London: 2011. Hypertension: the clinical management of primary hypertension in adults: update of Clinical Guidelines 18 and 34. Clinical Guideline 127.
    1. National Heart Foundation of Australia . National Health Foundation of Australia; Melbourne: 2016. Guideline for diagnosis and management of hypertension in adults—2016.
    1. Ministry of Health New Zealand Cardiovascular disease risk assessment and management for primary care. Feb 14, 2018.
    1. Ikeda N, Hasegawa T, Hasegawa T, Saito I, Saruta T. Awareness of the Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2000) and compliance to its recommendations: surveys in 2000 and 2004. J Hum Hypertens. 2006;20:263–266.
    1. Hyman DJ, Pavlik VN. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med. 2000;160:2281–2286.
    1. Campbell NR, Sheldon T. The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies? Curr Opin Cardiol. 2010;25:366–372.
    1. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health And Nutrition Examination Survey, 2001 to 2010. Circulation. 2012;126:2105–2114.
    1. Robson J, Dostal I, Sheikh A. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open. 2016;6
    1. Victor RG, Lynch K, Li N. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med. 2018;378:1291–1301.
    1. Serumaga B, Ross-Degnan D, Avery AJ. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ. 2011;342:d108.
    1. NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389:37–55.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe