Journal of the American Society of Hypertension 10(10) (2016) 753–754

Editor’s Page

‘‘I have asked my friend and Special Section editor Michael Bloch to write this month’s editorial on a topic that is dear to
his heart.’’
Daniel Levy, Editor-in-Chief

Worldwide prevalence of hypertension exceeds 1.3

billion
Michael J. Bloch, MD, FACP, FASH, FSVM, FNLA
Associate Professor, Department of Medicine, University of Nevada School of Medicine, Reno, NV, USA; and
Medical Director, Department of Vascular Care, Renown Institute for Heart and Vascular Health, Reno, NV, USA

Using available population-based observational studies,
Mills et al1 give us a sweeping view of the global burden
of hypertension, the leading preventable cause of death
worldwide. While the methodology of each of the indi-
vidual studies included in this systematic analysis is
inconsistent and much of the data from certain parts of
the globe are somewhat limited, the broad conclusions
of this paper are striking. The authors estimate that in
2010, the worldwide prevalence of hypertension was
1.39 billion persons, representing 31% of all adults.
This represented a 5.2% increase in the global prevalence
between 2000 and 2010.
These data also highlight increasing disparities in
hypertension prevalence between high-income and low/
middle–income countries. From 2000 to 2010, the preva-
lence of hypertension decreased by 2.6% in high-income
countries, but increased by 7.7% in low/middle–income
countries. Almost three times as many people with hyper-
tension live in low/middle–income countries (1.04 billion)
than in high-income countries (694 million).
In terms of the overall burden of hypertension, the dispa-
rate trends in prevalence between high-income and low/
middle–income countries is magnified by disparities in
awareness, treatment, and control rates. From 2000 to
2010, high-income countries saw substantial improvements
in awareness (58.2%–67.0%), treatment (44.5%–55.6%),
and control (17.9%–28.4%). While these rates still demon-
strate substantial room for improvement, they are far supe-
rior to the rates seen in low/middle–income countries where
there has been little improvement and perhaps some wors-
ening in the rates of awareness (32.3%–37.9%), treatment
(24.9%–29.0%), and control (8.4%–7.7%) from 2000
to 2010.
The large and increasing disparities in the global burden
of inadequately treated hypertension demand urgent atten-
tion and perhaps a change in tactics. The World Heart
Federation has set a lofty goal of improving hypertension
control rates globally by 25% by the year 2025.2 This
goal also demands a substantial reduction in global dispar-
ities in the burden of hypertension.
Obviously, healthcare delivery faces numerous and var-
ied obstacles in many low/middle–income countries,
including limited resources. If we are mostly concerned
with an absolute decrease in the risk of heart disease and
stroke, perhaps a modest change in tactics would be help-
ful. Ensuring strict blood pressure control is generally a
resource intensive project—even high-income countries
have suboptimal control rates. Perhaps, in low/middle–
income countries, interventions that focus on increasing
blood pressure screening and education (awareness) with
immediate treatment of those found to have hypertension
(including promoting long-term adherence) rather than pri-
marily focusing on control may be an achievable interim
step. If a majority of people with hypertension worldwide
were identified and treated with low-dose fixed combina-
tion antihypertensive medications, the burden of subsequent
cardiovascular events would almost certainly decrease,
regardless of the absolute achieved blood pressure. Addi-
tionally, any population-based improvements in sodium
intake, exercise habits, and avoidance of weight gain would
help to slow the increase in hypertension prevalence in low/
middle–income countries.

E-mail: michael@bluesprucemed.com

1933-1711/$ - see front matter Ó 2016 American Society of Hypertension. All rights reserved.
http://dx.doi.org/10.1016/j.jash.2016.08.006
754 M.J. Bloch / Journal of the American Society of Hypertension 10(10) (2016) 753–754
Whatever the solution, these data make abundantly clear
that while we may be making gains against the burden of
hypertension in the United States and other high-income
countries, we are currently losing the battle globally.
References
1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM,
Reynolds K, et al. Global disparities of hypertension
prevalence and control: a systematic analysis of popula-
tion based studies from 90 countries. Circulation 2016;
134:441–50.
2. Adler AJ, Prabhakaran D, Bovet P, Kazi DS,
Mancia G, Mungal-Singh V, et al. Reducing
cardiovascular mortality through prevention and man-
agement of raised blood pressure: a World
Heart Federation Road Map. Glob Heart 2015;10:
111–22.