Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys

Abstract

Background: Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in high-income countries.

Methods: We used data from people aged 40-79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg).

Findings: Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%.

Interpretation: Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control.

Funding: Wellcome Trust and WHO.

Figure 1

Trends in hypertension prevalence by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.

Figure 2

Prevalence of hypertension and rates of awareness, treatment, and control in women and men aged 40–79 years Data are from the latest national survey in each country. Results shown are crude (ie, not age-standardised) to reflect the total burden of hypertension and its awareness, treatment, and control. Age-specific results, and their uncertainty, are available in Figure 1, Figure 3, Figure 4, Figure 5, Figure 6, and the appendix (pp 7–9). For each outcome, the colour range for cells extends from lowest to highest value. Men and women share the same colour scheme. Awareness, treatment, and control are reported as the proportions. *The latest national survey in Ireland had data for people aged 50 to 79 years; data from an earlier survey in 2007 were used for people aged 40 to 49 years. †The question on awareness was not asked in 2015 in Japan; awareness data from 2010 were used. ‡The latest national survey in Spain had data for people aged 60 to 79 years; data from an earlier survey in 2009 were used for people aged 40 to 59 years.

Figure 3

Trends in hypertension awareness and treatment among people with hypertension, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.

Figure 3

Trends in hypertension awareness and treatment among people with hypertension, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.

Figure 4

Age patterns of hypertension awareness, treatment, and control among women and men, according to the latest national surveys

Figure 5

Trends in proportion of people with hypertension who had undiagnosed or untreated stage 2 hypertension, by country, sex, and age group Error bars indicate 95% CIs.

Figure 5

Trends in proportion of people with hypertension who had undiagnosed or untreated stage 2 hypertension, by country, sex, and age group Error bars indicate 95% CIs.

Figure 6

Trends in hypertension control, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.

Figure 6

Trends in hypertension control, by country, sex, and age group See appendix (pp 29–41) for country-by-country results. Error bars indicate 95% CIs.