The number of adults living with hypertension worldwide has doubled over the past 30 years and is directly linked to more than 8.5 million deaths worldwide each year.

Over 331 million women and 317 million men were estimated to have hypertension in 1990 increasing to 626 million women and 652 million men in 2019. Most of this increase occurred in low- and middle-income countries (LMICs), according to an international study, published in The Lancet.

The study analysed blood pressure measurements from more than 100 million people taken over three decades in 184 countries.

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Despite being straightforward to diagnose and relatively easy to treat with low-cost drugs, nearly half of people (41% of women and 51% of men) with hypertension worldwide in 2019 were unaware of their condition; and more than half of women (53%) and men (62%) with the condition weren’t treated. Worldwide, blood pressure was controlled in fewer than one in four women and one in five men with hypertension.

High blood pressure is directly linked to more than 8.5 million deaths worldwide each year and is the leading risk factor for stroke, ischaemic heart disease, other vascular diseases, and renal disease. Lowering blood pressure can cut the number of strokes by 35%-40%, heart attacks by 20%-25%, and heart failure by around 50%.

Global progress in hypertension management has been slow

Professor Majid Ezzati, Imperial College London, UK, the senior author of the study, said: “Despite medical and pharmacological advances over decades, global progress in hypertension management has been slow, and the vast majority of people with hypertension remain untreated, with large disadvantages in low- and middle-income countries.

“Our analysis has revealed good practice in diagnosing and treating hypertension not just in high-income countries but also in middle-income countries. These successes show that preventing high blood pressure and improving its detection, treatment, and control are feasible across low- and middle-income settings if international donors and national governments commit to addressing this major cause of disease and death.” 

The Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) analysed data from 1,201 population-representative studies, involving 104 million people from 184 countries (covering 99% of the world’s population). The authors only used data from studies that had measured blood pressure to avoid biases in self-reported data. Hypertension was defined as having systolic blood pressure of 140mmHg or greater, diastolic blood pressure of 90mmHg or greater, or taking medication for high blood pressure.

Modelling was used to estimate prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis, who were taking medication for hypertension, and whose hypertension was controlled to below 140/90 mm Hg, by country, year, and age.

The authors note that whilst the study provides the first comparable estimates of blood pressure prevalence, diagnosis, treatment and control in adults for all countries of the world, it may be affected by a lack of data in some countries, especially in Oceania and sub-Saharan Africa.

Writing in a linked Comment, Dr Clara Chow from the University of Sydney, Australia, (who was not involved in the study) says, “There is an urgent need for a transformation and innovative approaches to reduce the burden of hypertension globally. We need better strategies to increase diagnosis and management, leveraging primary care or existing systems or identifying new methods to engage consumers in blood pressure management. With such vast differences in rates of prevalence, treatment, and control across countries there is a need to examine local implementation.

"From a medical model point of view, digital transformation such as telemonitoring, home blood pressure monitoring, text message reminders to improve adherence, and other digital health interventions to encourage healthy behaviours, or simpler medical regimens such as initial treatment with a combination therapy—such as a single pill containing ultra-low-dose quadruple combination therapy—should be considered to address barriers to blood pressure control."

For more news and articles on hypertension go to our cardiology section