Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectivelycontrol hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment,and control from 1990 to 2019 for 200 countries and territories.Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies withmeasurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolicblood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication forhypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and theproportion of people with hypertension who had a previous diagnosis (detection), who were taking medication forhypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The modelallowed for trends over time to be non-linear and to vary by age.Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credibleinterval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698)million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalencewas lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countriesin western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-incomecountries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% forwomen in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, andLatin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosisof hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among peoplewith hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rateswere highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica,Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal,Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men inthese countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment andcontrol rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africaand Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income andrecently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantiallyacross countries, with some middle-income countries now outperforming most high-income nations. Thedual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment andcontrol is achievable not only in high-income countries but also in low-income and middle-income settings.