Worldwide, more than 1.2 billion people between the ages of 30 and 79 suffer from high blood pressure – almost twice as many as 30 years ago. This is shown by an analysis that evaluated studies with data from over 100 million people worldwide. According to this, the proportion of high blood pressure patients in relation to the total population has remained almost the same, but there are large differences between the countries. In countries with middle and low incomes in particular, the number of cases has increased and many of those affected are not being adequately treated.
High blood pressure is one of the most important risk factors for stroke, various heart and vascular diseases and kidney problems. It is responsible for more than 8.5 million deaths each year worldwide. Inexpensive drugs are available for treatment that significantly reduce the risk of secondary diseases. Changing your lifestyle towards more exercise and a healthy diet can also help lower your blood pressure. However, many people with high blood pressure are not adequately treated.
Around every third adult has high blood pressure
The NCD Risk Factor Collaboration, led by Majid Ezzati from Imperial College London, has now worked with the World Health Organization to analyze how the occurrence, diagnosis and treatment of high blood pressure have developed worldwide since 1990. To this end, the researchers evaluated more than 1,000 population-representative studies from 184 countries, which included data from around 104 million people.
Accordingly, the number of people between 30 and 79 years of age with high blood pressure has almost doubled since 1990: For women from 331 million to 626 million, for men from 317 million to 652 million. However, the main reason for this increase in absolute numbers is population growth. The age-standardized prevalence has remained largely constant for 30 years at around a third of men and women.
Big differences between countries
But even if the numbers seem to be stagnating on a global basis, there are clear differences in development at the country level. “The stable global prevalence was a net effect of a decrease in high-income countries and an increase in some low- and middle-income countries,” the researchers report. The number of cases fell particularly sharply in Canada and Peru. In 2019, less than a quarter of men and women in these countries had high blood pressure. In Germany, too, the numbers fell sharply between 1990 and 2019, for women from 42.8 percent to 25 percent, for men from 53.2 percent to 34.4 percent. In Paraguay, on the other hand, more than every second adult had high blood pressure in 2019.
Although high blood pressure is easy to diagnose and relatively easy to treat with inexpensive drugs, in 2019 almost half of people with high blood pressure worldwide knew nothing about their condition, and more than half of women (53 percent) and men (62 percent) with high blood pressure were not treated. Only 23 percent of women and 18 percent of men had their blood pressure adjusted with medication so that it was within the normal range.
Here, too, the researchers found large differences between the countries. The front runners were South Korea, Canada and Iceland, where more than 70 percent of those affected were treated in 2019 and blood pressure was well controlled in more than half of men and women. Germany and the USA also achieved similarly good ratings. In contrast, in Nepal, Indonesia, Oceania and several sub-Saharan African countries, fewer than a quarter of women and a fifth of men were treated, and less than 10 percent had well-controlled blood pressure.
Innovative approaches needed
“Despite decades of medical and pharmacological advances, the world has made slow progress in treating high blood pressure and the vast majority of people with high blood pressure remain untreated, with low- and middle-income countries being severely disadvantaged,” says Ezzati. On the other hand, the analysis also gives examples from countries like Costa Rica that diagnose and treat high blood pressure at a similarly good level as Germany and the USA.
“These achievements show that preventing high blood pressure and improving its detection, treatment and control in low- and middle-income countries are possible when international donors and national governments commit to addressing this important cause of disease and death,” so Ezzati. For example, it is important to give everyone the opportunity to eat a healthy diet that is rich in fruit and vegetables and contains little salt. In addition, primary health care needs to be expanded and access to medication improved.
Clara Chow from the University of Sydney, who was not involved in the study, wrote in an accompanying comment: “We urgently need innovative approaches to reduce the burden of high blood pressure worldwide. Given the large differences between countries, it is necessary to examine the local implementation. The stagnation in global prevalence and the fact that only around one in five people around the world have their blood pressure properly controlled should serve as a wake-up call. “
Source: NCD Risk Factor Collaboration, Lancet, doi: 10.1016 / S0140-6736 (21) 01330-1