Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

NCD Risk Factor Collaboration (NCD-RisC)

Abstract

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.

Conflict of interest statement

Declaration of interests 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.

Copyright © 2021 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Figures

Figure 1
Figure 1
Number of data sources by country
Figure 2
Figure 2
Prevalence of hypertension in 2019 and change from 1990 to 2019 in women and men Prevalence of hypertension in 2019 and change from 1990 to 2019 in women (A) and men (B). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows results ordered within regions and super-regions with 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension prevalence in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 2
Figure 2
Prevalence of hypertension in 2019 and change from 1990 to 2019 in women and men Prevalence of hypertension in 2019 and change from 1990 to 2019 in women (A) and men (B). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows results ordered within regions and super-regions with 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension prevalence in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 3
Figure 3
Hypertension treatment cascade in 2019, for women and men globally and by region Data are estimate (95% credible interval). Each stream shows the loss of people with hypertension throughout the treatment cascade and its associated percentage for women and men.
Figure 4
Figure 4
Proportion of women and men with hypertension who used treatment and whose blood pressure was controlled in 2019, and change from 1990 to 2019 See the appendix (pp 52–53) for control rates among those on treatment and for a comparison of treatment and control rates (pp 54–55). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension treatment and control rates in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 4
Figure 4
Proportion of women and men with hypertension who used treatment and whose blood pressure was controlled in 2019, and change from 1990 to 2019 See the appendix (pp 52–53) for control rates among those on treatment and for a comparison of treatment and control rates (pp 54–55). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension treatment and control rates in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 4
Figure 4
Proportion of women and men with hypertension who used treatment and whose blood pressure was controlled in 2019, and change from 1990 to 2019 See the appendix (pp 52–53) for control rates among those on treatment and for a comparison of treatment and control rates (pp 54–55). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension treatment and control rates in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 4
Figure 4
Proportion of women and men with hypertension who used treatment and whose blood pressure was controlled in 2019, and change from 1990 to 2019 See the appendix (pp 52–53) for control rates among those on treatment and for a comparison of treatment and control rates (pp 54–55). The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in hypertension treatment and control rates in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country. See the appendix (pp 33–46) for numerical results.
Figure 5
Figure 5
Proportion of women and men with hypertension who had systolic blood pressure 160 mm Hg or greater or diastolic blood pressure 100 mm Hg or greater but were not diagnosed or treated, in 2019, and change from 1990 to 2019 The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in the proportion of people with hypertension who had systolic blood pressure 160 mm Hg or greater or diastolic blood pressure 100 mm Hg or greater but were not diagnosed or treated, in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country.
Figure 5
Figure 5
Proportion of women and men with hypertension who had systolic blood pressure 160 mm Hg or greater or diastolic blood pressure 100 mm Hg or greater but were not diagnosed or treated, in 2019, and change from 1990 to 2019 The density plot alongside each map shows the distribution of estimates across countries. The top right graph in each panel shows the results ordered within regions and super-regions with their 95% credible intervals. The bottom right graph in each panel shows the change from 1990 to 2019 in the proportion of people with hypertension who had systolic blood pressure 160 mm Hg or greater or diastolic blood pressure 100 mm Hg or greater but were not diagnosed or treated, in relation to the uncertainty of the change measured by posterior SD. Shaded areas show the posterior probability of an estimated increase or decrease being a true increase or decrease. Each point shows one country.
Figure 6
Figure 6
Trends in the number of people with hypertension who reported a diagnosis, who used treatment, and whose blood pressure was effectively controlled, globally and by region, 1990–2019 See the appendix (pp 58–60) for trends in the percentage of people with hypertension who reported a diagnosis, who had treatment, and whose blood pressure was effectively controlled, globally and by region.

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