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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension

Nature Reviews Cardiology volume 18, pages 785–802 (2021)Cite this article

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Abstract

High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country’s financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.

Key points

  • Hypertension is more prevalent in low-income and middle-income countries than in high-income countries.

  • In 2015, 8.5 million deaths were associated with high blood pressure, 88% of which were in low-income and middle-income countries.

  • Population-level measures, such as increasing the availability and affordability of fresh fruits and vegetables and lowering the sodium content of packaged and prepared foods, can lower blood pressure in the entire population.

  • Effective use of pharmacological treatment for people with hypertension varies substantially globally and is particularly low in low-income and middle-income countries.

  • Scaling up treatment coverage and improving its effectiveness can substantially reduce the health burden of hypertension.

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Fig. 1: Changes in blood pressure by region.
Fig. 2: Worldwide systolic blood pressure.
Fig. 3: Worldwide diastolic blood pressure.
Fig. 4: Worldwide prevalence of raised blood pressure.
Fig. 5: Association between country characteristics and blood pressure.
Fig. 6: Comparison of female and male blood pressures.
Fig. 7: Deaths attributable to high blood pressure.

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Acknowledgements

B.Z. is supported by an Institutional Strategic Support Fund Springboard Fellowship from the Wellcome Trust.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Bin Zhou & Majid Ezzati

  2. MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK

    Bin Zhou & Majid Ezzati

  3. The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK

    Bin Zhou & Majid Ezzati

  4. Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK

    Pablo Perel

  5. Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

    George A. Mensah

  6. Regional Institute for Population Studies, University of Ghana, Accra, Ghana

    Majid Ezzati

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  4. Majid Ezzati
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B.Z. researched data for the article. All the authors contributed to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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Correspondence to Majid Ezzati.

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M.E. reports a charitable grant from the AstraZeneca Young Health Programme and personal fees from Prudential, unrelated to this Review. The other authors declare no competing interests.

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Nature Reviews Cardiology thanks D. Arnett and C. Tsioufis for their contribution to the peer review of this work.

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Zhou, B., Perel, P., Mensah, G.A. et al. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 18, 785–802 (2021). https://doi.org/10.1038/s41569-021-00559-8

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