Hypertension Cases Skyrocket – Mostly in Low and Middle-Income Countries
Hypertension cases have increased to 1.28 billion in 30 years and millions of people are living with untreated hypertension.

The number of adults around the world with hypertension has almost doubled from 650 million to 1.28 billion in 30 years – and nearly half these people don’t know they have hypertension, a new study published in The Lancet has found.

The study, which is the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment, and control also found that more than one billion people with high blood pressure  — 82% of hypertension patients in the world — lived in low- and middle-income countries in 2019.

The international study, led by researchers from Imperial College London and the World Health Organization (WHO), analysed blood pressure measurements from 104 million people in the 30 to 79 age group and was taken over three decades in 184 countries. 

“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,” lead author of the study Professor Majid Ezzati, Imperial College London, UK, said.

“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.”

Hypertension is defined as systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking medication for high blood pressure. It is directly linked to more than 8.5 million deaths worldwide each year and is the leading risk factor for strokes, 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%. 

The study found that globally, the number of adults aged 30 to 79 with hypertension jumped from an estimated 331 million women and 317 million men in 1990 to 626 million women and 652 million men in 2019. 

Increase mostly seen in low- and middle-income countries

The data further pointed to regional disparities in treatment and control of high blood pressure despite the easy diagnosis and low cost of medicines.

Dr Bin Zhou, a research fellow at the School of Public Health at Imperial College London, who led the analysis said: “Although hypertension treatment and control rates have improved in most countries since 1990, there has been little change in much of sub-Saharan Africa and Pacific Island nations.  International funders and national governments need to prioritise global treatment equity for this major global health risk.”

Canada, Iceland, and South Korea had among the lowest prevalence of hypertension with treatment levels greater than 70%; and control rates of over 50% in 2019. 

Encouragingly, large improvements in treatment and control rates were seen in some middle-income countries including Costa Rica, Kazakhstan, South Africa, Brazil, Turkey, and Iran over the 30 years. 

Some of the highest rates were seen in the Dominican Republic, Jamaica, and Paraguay for women and Hungary, Paraguay, and Poland for men.

“Policies that enable people in the poorest countries to access healthier foods—particularly reducing salt intake and making fruit and vegetables more affordable and accessible—alongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries,” said Ezzati about the large improvements in some of the countries.

Over half of hypertension sufferers were unaware of their condition

Hypertension is relatively easy to treat with low-cost drugs yet 720 million people were not on treatment.

Another significant finding was that about 580 million people with hypertension were unaware of their condition because they were never diagnosed and 720 million did not receive the required treatment.

Although the condition is straightforward to diagnose and relatively easy to treat with low-cost drugs, almost 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 were not treated for it. Worldwide, blood pressure was controlled in fewer than one in four women and one in five men with hypertension. 

“Nearly half a century after we started treating hypertension, which is easy to diagnose and treat with low-cost medicines, it is a public health failure that so many of the people with high blood pressure in the world are still not getting the treatment they need,” said Ezzati.

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.

New WHO guideline for hypertension treatment

This week, the World Health Organization (WHO) released fresh guidelines after 20 years for pharmacological treatment of hypertension in adults to help countries manage the condition better.  

The recommendations cover the level of blood pressure to start medication, type of medicine or combination of medicines to use, target blood pressure level, and frequency of tests.

“The need to better manage hypertension cannot be exaggerated. By following the recommendations in this new guideline, increasing and improving access to blood pressure medication, identifying and treating comorbidities such as diabetes and pre-existing heart disease, promoting healthier diets and regular physical activity, and more strictly controlling tobacco products, countries will be able to save lives and reduce public health expenditures,” said Dr Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases.

Image Credits: John Campbell/Flickr, REUTERS/Baz Ratner, Pxhere.

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.