Hypertension on the Rise in Low- and Middle-Income Countries

The burden of hypertension has shifted over the last 16 years, resulting in a greater prevalence of the disease in low- and middle-income countries than in high-income countries for the first time in history, a new analysis shows.

Senior researcher Jiang He, MD, PhD (Tulane University School of Public Health and Tropical Medicine, New Orleans, LA), told TCTMD that changes in lifestyle factors, including increased salt, fat, and calorie intake, along with decreased physical activity, are a main contributor to the changes seen in middle- and low-income countries.

“On the other hand, the prevalence of hypertension has been stable, or even reduced, in higher-income countries because of primary prevention efforts and [emphasis on] a healthy lifestyle,” He said. The paper was published online August 8, 2016 ahead of print in Circulation.

Led by He’s colleague Katherine T. Mills, PhD (Tulane University School of Public Health and Tropical Medicine), the study found that 31.1% of people residing in low- to middle-income countries—amounting to approximately 1.4 billion people—had hypertension as of 2010. In comparison, the prevalence was 28.5% in high-income nations. The numbers represent a 7% increase for low- and middle-income countries from 2000 to 2010, compared with a 2.6% decrease over the same time for the high-income countries. Low- and middle-income areas that appear to have experienced the greatest increases in absolute burden of hypertension were in East Asia and Pacific, South Asia, and sub-Saharan Africa.

Awareness, treatment, and control of hypertension all increased in high-income countries during the study period, while low- and middle-income countries saw only slight improvements in awareness and treatment accompanied by a decrease in adequate hypertension control.

According to He, low- and middle-income countries face more of a challenge in getting out public health messages about hypertension awareness than high-income countries.

“We believe that on a global level everyone has to work together to deal with this most important public health challenge,” He said. In addition to lifestyle factors, the researchers say, overburdened healthcare systems also are likely to blame for the disparities seen globally.

Call for ‘Public Interest’

In an editorial accompanying the study, Andrew E. Moran, MD, MPH (Columbia University Medical Center, New York, NY), notes that the growing epidemic of hypertension in low- and middle-income countries is “sobering.” What is needed now, he asserts, is “the will to apply” prevention, treatment, and control strategies worldwide.

Moran observes that one reason hypertension awareness is poor in low- and middle-income countries is the reduced availability of screening. Some solutions, if access to primary ambulatory medical care facilities is limited, are pharmacies, work sites, houses of worship, and mobile vans equipped with standard equipment and trained personnel. Additionally, he suggests, access to affordable medication is another barrier in those countries that may be improved via use of fixed-dose combination pills and more frequent contact with cost-effective healthcare providers such as nurses, community health workers, or pharmacists.

“Health professionals alone cannot spur public interest in hypertension,” Moran writes. “It will take experts in communications, celebrity advocates, and local community champions to bring home the dangers of hypertension to the public. Only then will public interest in and action against hypertension match the magnitude of the problem.”


  • Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;Epub ahead of print. 
  • Moran AE. Still on the road to worldwide hypertension control. Circulation. 2016;Epub ahead of print. 


  • He and Moran report no relevant conflicts of interest. 

Related Stories: