Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries

Abstract

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.

Keywords: epidemiology; global health; hypertension; prevention & control.

© 2016 American Heart Association, Inc.

Figures

Figure 1

Flowchart of study selection

Figure 2. Worldwide age- and sex-standardized prevalence of hypertension in adults 20 years and older by country

Upper panel shows country-specific prevalence in 2010 and lower panel shows country-specific prevalence in 2000. Maps are shaded according to prevalence, from light (lower prevalence) to dark (higher prevalence).

Figure 3. Age-standardized prevalence of hypertension in adults 20 years and older by world region and sex

Upper panel shows sex-specific prevalence by world region in 2010 and lower panel shows sex-specific prevalence by world region in 2000. Comparisons between 2010 and 2000 prevalences were statistically significant (p

Figure 4. Absolute burden of hypertension in adults 20 years and older by world region and sex

Upper panel shows number of hypertensive individuals in millions by world region and sex in 2010 and lower panel shows number of hypertensive individuals in millions by world region and sex in 2000. Comparisons between 2010 and 2000 absolute numbers were statistically significant (p