Hypertension is Now More Common in Poor and Middle-Income Countries Than Rich Ones

Middle- and lower-income countries now have a higher rate of hypertension than high-income countries. Worldwide, the prevalence of hypertension is at a record high, according to a new study in the journal Circulation.

From 2000 to 2010, the rate of hypertension in middle- and lower-income countries increased by nearly eight percent. For higher-income countries in that same time period, it decreased by nearly three percent. “If you look over the past 10 years, the number of hypertensive people has decreased in higher income countries, but it’s higher in lower-income countries,” said Jiang He of Tulane University School of Public Health, a leader of the study.

He and his team combed through studies published from Jan. 1, 1995 to Dec. 31, 2014. The studies they analyzed addressed sex and age-specific high blood pressure rates, and they grouped countries using a World Bank classification system.

The researchers estimated that 1.39 billion of adults across the globe had high blood pressure in 2010 compared to 921 million in 2000. The prevalence of hypertension in high-income countries dropped from 31.1 percent in 2000 to 28.5 percent in 2010, while the prevalence increased over that time from 23.8 to to 31.5 percent in middle and low-income countries.

The study found that the East Asia and Pacific region had the highest rate and increase in adults with hypertension; nearly 439 million people there have hypertension. The South Asia and Sub-Saharan Africa regions also had a significant uptick in high blood pressure prevalence, with 114 million more people and 78 million more people respectively living with hypertension in 2010 than in 2000.

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Changes in urbanization and diet are likely explanations for why hypertension is now an issue in middle- and lower-income countries, according to the study. “People who live in the countryside engage in the farmer lifestyle and have manual labor,” He said. “When they move to the city, they get office jobs and stress.” The study also found that there were disparities between middle and lower-income countries and high-income countries when it came to hypertension awareness and treatment. Only 38 percent of people in middle- and lower-income countries were aware of their high blood pressure status compared to 67 percent of people in high-income countries. Moreover, 56 percent of high-income residents were likely to receive treatment compared to 29 percent in middle- and lower-income countries.

Samira Asma is the chief of the Global Noncommunicable Diseases Branch in the Centers for Disease Control’s Division of Global Health Protection. She said the WHO estimates that nearly one third of all deaths in the world will be caused by cardiovascular diseases, which is about 25 million deaths per year. “Eight out of 10 of those deaths will be for low- to middle-income countries,” she said. Asma said that hypertension has declined in high-income countries because of lifestyle changes and more information about what is in food. Asma and He of Tulane agree that national and international stakeholders should collaborate to find ways to combat hypertension.

Mpower, a WHO effort to decrease tobacco use, is an example of how even middle- and lower-income countries can decrease the rate of hypertension, said Asma. Bans on tobacco advertising decreased tobacco consumption, according to the WHO.

Asma said similar methods can be implemented globally to reduce the rate of hypertension, which she said prematurely ages the heart by up to seven years. “We should not let any patient go undiagnosed and untreated,” Asma said. She called for “putting in an effective system where people have access to medication and can receive treatment and can be deployed in lower-income countries.”