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More than 700 million people with untreated hypertension

World Health Organization and Imperial College London joint press release

The number of adults aged 30–79 years with hypertension has increased from 650 million to 1.28 billion in the last thirty years, according to the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment and control, led by Imperial College London and WHO, and published today in The Lancet. Nearly half these people did not know they had hypertension.

Hypertension significantly increases the risk of heart, brain and kidney diseases, and is one of the top causes of death and disease throughout the world. It can be easily detected through measuring blood pressure, at home or in a health centre, and can often be treated effectively with medications that are low cost.

The study, conducted by a global network of physicians and researchers, covered the period 1990–2019. It used blood pressure measurement and treatment data from over 100 million people aged 30–79 years in 184 countries, together covering 99% of the global population, which makes it the most comprehensive review of global trends in hypertension to date.

By analysing this massive amount of data, the researchers found that there was little change in the overall rate of hypertension in the world from 1990 to 2019, but the burden has shifted from wealthy nations to low- and middle-income countries. The rate of hypertension has decreased in wealthy countries – which now typically have some of the lowest rates – but has increased in many low- or middle-income countries.

As a result, Canada, Peru and Switzerland had among the lowest prevalence of hypertension in the world in 2019, while some of the highest rates were seen in the Dominican Republic, Jamaica and Paraguay for women and Hungary, Paraguay and Poland for men. (See notes to editors for country breakdowns/rankings).

Although the percent of people who have hypertension has changed little since 1990, the number of people with hypertension doubled to 1.28 billion. This was primarily due to population growth and ageing. In 2019, over one billion people with hypertension (82% of all people with hypertension in the world) lived in low- and middle-income countries.

Significant gaps in diagnosis and treatment

Although it is straightforward to diagnose hypertension and relatively easy to treat the condition with low-cost drugs, the study revealed significant gaps in diagnosis and treatment. About 580 million people with hypertension (41% of women and 51% of men) were unaware of their condition because they were never diagnosed.  

The study also indicated that more than half of people (53% of women and 62% of men) with hypertension, or a total 720 million people, were not receiving the treatment that they need. Blood pressure was controlled, which means medicines were effective in bringing blood pressure to normal ranges, in fewer than 1 in 4 women and 1 in 5 men with hypertension.

Professor Majid Ezzati, senior author of the study and Professor of Global Environmental Health at the School of Public Health at Imperial College London, said: “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.”

Men and women in Canada, Iceland and the Republic of Korea were most likely to receive medication to effectively treat and control their hypertension, with more than 70% of those with hypertension receiving treatment in 2019. Comparatively, men and women in sub-Saharan Africa, central, south and south-east Asia, and Pacific Island nations are the least likely to be receiving medication. Treatment rates were below 25% for women, and 20% for men, in a number of countries in these regions, creating a massive global inequity in treatment.

Encouragingly, some middle-income countries have successfully scaled up treatment, and are now achieving better treatment and control rates than most high-income nations. For example, Costa Rica and Kazakhstan now have higher treatment rates than most higher-income countries.

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 prioritize global treatment equity for this major global health risk.”

New WHO guideline for hypertension treatment

The ‘WHO Guideline for the pharmacological treatment of hypertension in adults’, also released today, provides new recommendations to help countries improve the management of hypertension.

Dr Taskeen Khan, of WHO’s Department of Noncommunicable Diseases, who led the guideline development, said: “The new global guideline on the treatment of hypertension, the first in 20 years, provides the most current and relevant evidence-based guidance on the initiation of medicines for hypertension in adults.”

The recommendations cover the level of blood pressure to start medication, what type of medicine or combination of medicines to use, the target blood pressure level, and how often to have follow-up checks on blood pressure. In addition, the guideline provides the basis for how physicians and other health workers can contribute to improving hypertension detection and management.

Dr Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases added: “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.”

NOTES TO EDITORS

‘Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1,201 population-representative studies with 104 million participants’ by the NCD Risk Factor Collaboration (NCD-RisC) is published in The Lancet. DOI: 10.1016/S0140-6736(21)01330-1

Data were taken from 1201 studies with 104 million participants in 184 countries, aged 30-79 years, with measurement of blood pressure and data on blood pressure treatment.

Hypertension was defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or taking medication for hypertension.

The Republic of Korea in this press release is indicated as South Korea in the associated paper.

Imperial College London

Imperial College London is one of the world’s leading universities. The College’s 20 000 students and 8000 staff are working to solve the biggest challenges in science, medicine, engineering and business.

Imperial is the world’s fifth most international university, according to Times Higher Education, with academic ties to more than 150 countries. Reuters named the College as the UK’s most innovative university because of its exceptional entrepreneurial culture and ties to industry.

Imperial staff, students and alumni are working round-the-clock to combat COVID-19. Imperial has nearly two thousand key workers, and is at the forefront of coronavirus epidemiology, virology, vaccine development and diagnostics. More than one thousand Imperial staff and students are volunteering to support the NHS. http://www.imperial.ac.uk/

The World Health Organization

Dedicated to the well-being of all people and guided by science, the World Health Organization (WHO) leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. WHO is the UN agency for heath that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. www.who.int


Top 10 countries with the lowest hypertension prevalence in 2019

WOMEN

Ranking Country Prevalence as % of population
1. Switzerland 17%
2. Peru 18%
3. Canada 20%
4. Taiwan (Province of China) 21%
5. Spain 21%
6. Republic of Korea 21%
7. Japan 22%
8. United Kingdom 23%
9. China 24%
10. Iceland 24%

MEN

Ranking Country Prevalence as % of population
1. Eritrea 22%
2. Peru 23%
3. Bangladesh 24%
4. Canada 24%
5. Ethiopia 25%
6. Solomon Islands 25%
7. Papua New Guinea 25%
8. Lao PDR 26%
9. Cambodia 26%
10. Switzerland 26%

Top 10 countries with the highest hypertension prevalence in 2019

WOMEN

Ranking  Country  Prevalence as % of population 
1.  Paraguay  51% 
2.  Tuvalu  51% 
3.  Dominica  50% 
4.  Dominican Republic  49% 
5.  Sao Tome and Principe   48% 
6.  Jamaica  48% 
7.  Haiti  48% 
8.  Iraq  48% 
9.  Eswatini 47% 
10.  Botswana  47% 

MEN

Ranking  Country  Prevalence as % of population
1.  Paraguay  62% 
2.  Hungary  56% 
3.  Poland  55% 
4.  Argentina  54% 
5.  Lithuania  54% 
6.  Romania  53% 
7.  Belarus  52% 
8.  Croatia  51% 
9.  Tajikistan  51% 
10.  Serbia  50% 

Top 10 countries with the highest hypertension treatment rate in 2019

WOMEN

Ranking  Country  Rate as % of all women with hypertension
1.  Republic of Korea 77%
2.  Costa Rica 76%
3.  Kazakhstan 74%
4.  United States of America 73%
5.  Iceland 72%
6.  Venezuela 71%
7.  El Salvador 71%
8.  Portugal 71%
9.  Canada 71%
10.  Slovakia 70%

MEN

Ranking  Country  Rate as % of all men with hypertension
1.  Canada 76%
2.  Iceland 71%
3.  Republic of Korea 67%
4.  United States of America 66%
5.  Kazakhstan 66%
6.  Malta 65%
7.  Costa Rica 63%
8.  Germany 61%
9.  Czechia 59%
10.  Singapore 59%

Top 10 countries with the lowest hypertension treatment rate in 2019

WOMEN

Ranking Country Rate as % of all women with hypertension
1. Rwanda 11%
2. Niger 15%
3. Kiribati 15%
4. Ethiopia 16%
5. Vanuatu 16%
6. Tanzania 17%
7. Solomon Islands 17%
8. Madagascar 19%
9. Mozambique 19%
10. Kenya 21%

MEN

Ranking Country Rate as % of all men with hypertension
1. Rwanda 10%
2. Kenya 10%
3. Mozambique 10%
4. Vanuatu 11%
5. Solomon Islands 11%
6. Niger 12%
7. Madagascar 13%
8. Uganda 13%
9. Togo 14%
10. Burkina Faso 14%

Top 10 countries with the largest increase in hypertension prevalence between 1990 and 2019

WOMEN

Ranking Country Percentage point increase (1990 – 2019)
1. Kiribati 13
2. Tonga 13
3. Tuvalu 12
4. Indonesia 12
5. Brunei Darussalam 10
6. Haiti 9
7. Jamaica 9
8. Myanmar 9
9. Samoa 9
10. Uzbekistan 9

MEN

Ranking Country Percentage point increase (1990 – 2019)
1. Uzbekistan 15
2. Argentina 13
3. Paraguay 10
4. South Africa 10
5. China 10
6. Brunei Darussalam 9
7. Tajikistan 8
8. Jamaica 8
9. Dominican Republic 8
10. Tuvalu 8

Top 10 countries with the largest decline in hypertension prevalence between 1990 and 2019

WOMEN

Ranking Country Percentage point decrease (1990 – 2019)
1. Germany 18
2. Spain 14
3. Japan 13
4. Singapore 12
5. Russian Federation 12
6. Italy 12
7. Austria 11
8. United Kingdom 11
9. Israel 11
10. Sweden 10

MEN

Ranking Country Percentage point decrease (1990 – 2019)
1. Germany 19
2. Switzerland 14
3. United Kingdom 13
4. Finland 12
5. Canada 12
6. Luxembourg 10
7. Norway 10
8. Austria 9
9. Italy 8
10. Malawi 8

Top 10 countries with the largest increase in treatment rate between 1990 and 2019

WOMEN

Ranking Country Percentage point increase (1990 – 2019)
1. Republic of Korea 46
2. Taiwan (Province of China) 38
3. South Africa 36
4. Costa Rica 35
5. Poland 35
6. Venezuela 35
7. Serbia 33
8. Brunei Darussalam 33
9. Singapore 33
10. Colombia 33

MEN

Ranking Country Percentage point increase (1990 – 2019)
1. Republic of Korea 50
2. Canada 46
3. Costa Rica 40
4. Germany 39
5. Iceland 39
6. Taiwan (Province of China) 37
7. Kazakhstan 37
8. Poland 36
9. Switzerland 36
10. Norway 34

Source WHO

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