Disparities Widen Across Regions as Global Hypertension Burden Grows

Hypertension’s burden has continued to rise around the world, with disparities between lower- versus higher-income countries diverging over the past 20 years, a meta-analysis confirms.

There were, however, some gains in measures of disease awareness, antihypertensive treatment, and blood pressure control. The results were published last week in JACC.

Samantha S. O’Connell, MS (Tulane University, New Orleans, LA), lead author of the new report, told TCTMD that this work is an extension of a 2016 study that included data from 2000 to 2010. “We wanted to see if the same sort of trends were continuing, or if things had gotten better in terms of prevalence, awareness, treatment, and control of hypertension,” O’Connell said, noting that she expected to see more improvements in low- and middle-income countries than did occur. The absence of that, she said, “was a little bit surprising.”

What’s clear is that at a global level, urgent action is needed, O’Connell stressed. “Hypertension is the leading modifiable risk factor for death and disability and cardiovascular events.” By making improved hypertension treatment better available to more people, and getting their blood pressure under control, she added, “we can reduce those negative outcomes.”

The researchers point to the numerous barriers that stand in the way of progress at a system, provider, and patient level. These include healthcare systems that lack a patient-centered approach to life-long management of hypertension, fragmented or delayed care, low health literacy, transportation and communication challenges, a lack of affordable antihypertensive medications, high pill burden, and inaccurate BP measurement devices, among others.

1.7 Billion Affected in 2020

Combining data from 287 studies spanning 6.1 million adults from 119 countries, researchers defined hypertension as mean systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or use of antihypertensive medication. These cutoffs were chosen based on the details available in the studies being analyzed.

By 2020, a third of adults around the world had hypertension, amounting to 1.71 billion people. The prevalence was lower in high-income countries, at 30.1%, compared with low-/middle-income countries, at 33.4%. These percentages correspond to about 395 million and 1.32 billion people, respectively.

Between 2000 and 2020, the age-standardized prevalence in high-income countries decreased by 2.7% and the absolute burden of affected individuals rose by 76 million. Yet awareness of their condition among patients with hypertension increased (from 57.7% to 69.2%), as did treatment (from 42.9% to 66.3%) and control rates (from 16.4% to 40.2%).

For low-/middle-income countries, both prevalence and burden increased, by 5.8% and 651 million people, respectively, over those two decades. Improvements were seen here as well, in awareness (from 29.1% to 46.1%), treatment (from 20.7% to 30.8%), and control (from 6.4% to 13.6%).

The highest age-standardized prevalence at the end of the study period, in 2020, was found in Latin America and the Caribbean, where hypertension affected 38.1% of men and 37.5% of women, and in sub-Saharan Africa, where 37.6% of men and 40.6% of women had the disease.

“These findings are consistent with the results of previous work and document a persistent disparity that has become even more striking in recent years,” O’Connell and colleagues write.

They add: “Following current trends, the number of people with hypertension will continue to increase, and, unless urgent action is taken, particularly in low-/middle-income countries, the vast majority will be of working age and at risk for preventable heart attacks, strokes, and dementia.”