Rates of Hypertension Double Globally Between 1990 - 2019

As hypertension is responsible for a worldwide total of 8.5 million deaths from stroke, ischemic heart disease, and renal disease, improving effective coverage of treatment for patients with the condition is an objective of many regional and national initiatives.

As a result, a lack of global data assessment on hypertension trends led investigators to collect information of national, regional, and global estimates of trends in hypertension from 1990 - 2019 in 200 countries.

The team, led by Professor Majid Ezzati, PhD, School of Public Health, Imperial College London, observed the number of people aged 30 - 79 years with hypertension doubled from 1990 - 2019, despite stable age-standardized prevalence.

Methods

The study used data from 1990 - 2019, on patients aged 30 - 79 years from population-representative samples at the national, sub-national, or community level. In addition, measurements of systolic blood pressure and diastolic blood pressure were measured and data on hypertension treatment was available.

Primary outcomes included prevalence of hypertension, proportion of people with hypertension who reported prior diagnosis (detection), taking medication for hypertension (treatment), and blood pressure was controlled (control).

Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or taking medication for hypertension.

They noted the analysis was restricted to men and women aged 30 - 79 years due to a low prevalence of hypertension below 30 years of age, as well as differences in guidelines in older ages.

In the analysis, the team used a Bayesian hierarchical model to estimate prevalence of hypertension and proportion of patients with a previous diagnosis (detection), taking medication (treatment) and hypertension controlled to below 140/90 mmHg (control).

The hierarchical model would allow for non-linear time trends and non-linear age patterns.

Results

A total of 1201 studies with data on 104 million participants were found, with 986 studies (82.1%) including information on previous diagnoses. In addition, 184 countries (99% of global population) had ≥1 data source, while 131 countries (94% of global population) had ≥2 data sources.

Data show the number of people aged 30 - 79 years with hypertension doubled from 1990 - 2019. It showed 331 million women (95% CI, 306 - 359) and 317 million men (95% CI, 292 - 344) had hypertension in 1990, compared with 626 million women (95% CI, 584 - 668) and 652 million men (95% CI, 604 - 698) in 2019.

Further, the prevalence of age-standardized hypertension in 2019 was lowest in Canada and Peru for both men and women, with Taiwan, South Korea, and countries in western Europe including Switzerland, Spain and the UK for women. Men had the lowest rates in some low-income and middle-income countries, including Eritrea, Bangladesh, Ethiopia, and the Solomon Islands.

Data show prevalence was >24% for women and >25% for men in 2019.

The highest hypertension prevalence surpassed 50% for women in 2 countries and men in 9 different countries, in central and eastern Europe, central Asia, Oceania, and Latin America.

Across the globe, 59% of women and 49% of men with hypertension reported a previous diagnosis in 2019, with 47% of women and 38% of men treated for hypertension. Data show hypertension control rates led to global control rates of 23% for women and 18% for men.

In 2019, investigators found treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), as well as the USA, Costa Rica, Germany, Portugal, and Taiwan.

On the other hand, treatment rates were found to be <25% for women and <20% for men in Nepal, Indonesia, and other countries in sub-Saharan Africa and Oceania and control rates were <10% for both women and men.

The team observed hypertension treatment and control rates improved in most countries since 1990, but there was little change observed in the majority of countries in sub-Saharan Africa and Oceania.

Improvements were found mostly in high-income countries, central Europe, and others including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.

Discussion

The analysis determined the number of people with hypertension worldwide has doubled since 1990, with the majority of the increase occurring in low-income and middle-income regions.

In addition, high-income countries have seen the prevalence of hypertension decline, while health systems have achieved treatment rates of ≤80% and control rates of ≤60%.

“Our country results show that preventing hypertension and enhancing its detection, treatment, and control is feasible not only in high-income countries, but also in low-income and middle-income nations,” investigators wrote.

They noted hypertension prevention and control will increase with increased access to universal health coverage and medications, as well as new technologies including tele-monitoring if patients have uninterrupted access to effective medication.

“Universal health insurance has been instrumental in achieving high effective coverage but should be complemented with primary care strengthening, evidence- based hypertension guidelines that are up to date and are adapted to the country contexts, health workforce training, and a robust system of drug procurement and distribution,” investigators wrote. “Programs should also be regularly assessed, both at the population level, as our work has done, and in health facilities to ensure accountability and stimulate improvement.”

The study, “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,” was published online in The Lancet.