In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Collaborative efforts urgently needed to combat the emerging hypertension burden in low- and middle-income countries

Comment by Eugenio Greco, EAPC Prevention, Epidemiology and Population Science Section

Prevention


Treatment and control of hypertension are critically important for the prevention of consequent cardiovascular and kidney diseases.

Current estimates of the global burden of hypertension in high-income and low- and middle-income countries are needed to better understand this important public health concern. The proportions of hypertension awareness, treatment, and control that have been reported across many countries vary substantially. However, these data have not been systematically analysed to provide pooled estimates in world regions with diverse economic development.

The authors searched on MEDLINE the studies published from 1 January, 1995 to 31 December, 2014; additional studies were identified by manual review of references cited in reviews, meta-analyses, and original studies. Countryspecific searches of the World Health Organization Global Infobase were also conducted.

They 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.

The results of the study were:

  • 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;
  • in 2010, less than half (46.5%) of adults with hypertension were aware of their condition, 36.9% were treated with antihypertensive medication, and only 13.8% had their blood pressure controlled worldwide. High-income countries had almost double the proportions of awareness (67.0% versus 37.9%) and treatment (55.6% versus 29.0%) and 4 times the proportion of control among patients with hypertension (28.4% versus 7.7%) in comparison with low- and middle income countries in 2010;
  • from 2000 to 2010, 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.

The comments of the authors were that the study is the first systematic analysis of global health disparities in hypertension prevalence, awareness, treatment, and control. It provides novel insights into several aspects of the global challenge of hypertension:

  • first, the study showed that the age-standardised prevalence of hypertension was higher in low- and middle-income countries (31.5%) than in high-income countries (28.5%) worldwide; in addition, approximately three-quarters of individuals with hypertension lived in low- and middle-income countries;
  • second, the study showed that the prevalence of hypertension decreased by 2.6% in high-income countries but increased by 7.7% in low- and middle-income countries from 2000 to 2010.

The conclusions of the authors were that global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology

References

Global Disparities of Hypertension Prevalence and Control.
A Systematic Analysis of Population-Based Studies From 90 Countries.
Katherine T. Mills, et Al.
Circulation. 2016;134:441–450. DOI: 10.1161/CIRCULATIONAHA.115.018912