Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension

Bin Zhou, Pablo Perel, George A Mensah, Majid Ezzati, Bin Zhou, Pablo Perel, George A Mensah, Majid Ezzati

Abstract

High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.

Conflict of interest statement

M.E. reports a charitable grant from the AstraZeneca Young Health Programme and personal fees from Prudential, unrelated to this Review. The other authors declare no competing interests.

© 2021. Springer Nature Limited.

Figures

Fig. 1. Changes in blood pressure by…
Fig. 1. Changes in blood pressure by region.
Changes in age-standardized mean systolic and diastolic blood pressure between 1975 and 2015 by region. The start and end points of each arrow represent the levels of blood pressure in 1975 and 2015, respectively. Rightward arrows indicate an increase in blood pressure, and leftward arrows indicate a decrease.
Fig. 2. Worldwide systolic blood pressure.
Fig. 2. Worldwide systolic blood pressure.
Age-standardized mean systolic blood pressure by country in 2015. Adapted from (ref.), CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).
Fig. 3. Worldwide diastolic blood pressure.
Fig. 3. Worldwide diastolic blood pressure.
Age-standardized mean diastolic blood pressure by country in 2015 (ref.).
Fig. 4. Worldwide prevalence of raised blood…
Fig. 4. Worldwide prevalence of raised blood pressure.
Age-standardized prevalence of raised blood pressure by country in 2015 (ref.).
Fig. 5. Association between country characteristics and…
Fig. 5. Association between country characteristics and blood pressure.
a | Relationship between mean systolic and diastolic blood pressure and per capita gross domestic product (GDP) for 1975 and 2015. b | Relationship between mean systolic and diastolic blood pressure and the proportion of the population living in urban areas for 1975 and 2015. c | Relationship between mean systolic and diastolic blood pressure and mean BMI for 1975 and 2015. In 1975, mean systolic and diastolic blood pressure were positively correlated with GDP, the proportion of the population living in urban areas and mean BMI. In 2015, mean blood pressure was no longer correlated with these country characteristics for men and negatively correlated with GDP and the proportion of the population living in urban areas for women. Each point shows one country, coloured by region.
Fig. 6. Comparison of female and male…
Fig. 6. Comparison of female and male blood pressures.
Comparison of female and male blood pressures in people aged 18–49 years and ≥50 years in 2015. Each point shows one country, coloured by region. The interaction between sex and age group was significant (P < 0.0001 for systolic and diastolic blood pressure) in an analysis of variance in a model with blood pressure as a dependent variable and sex, age group and their interaction as independent variables. Men aged 18–49 years have higher blood pressure levels than women of the same age in most countries, and men and women aged ≥50 years have on average similar blood pressure levels.
Fig. 7. Deaths attributable to high blood…
Fig. 7. Deaths attributable to high blood pressure.
Deaths attributable to high systolic blood pressure (SBP) in 1990 and 2015, coloured by region (part a) and cause of death (part b).

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