Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Apr 2;128(7):808-826.
doi: 10.1161/CIRCRESAHA.120.318729. Epub 2021 Apr 1.

Hypertension in Low- and Middle-Income Countries

Aletta E Schutte  1   2   3 , Nikhil Srinivasapura Venkateshmurthy  4   5   6 , Sailesh Mohan  4   5   7 , Dorairaj Prabhakaran  4   5   8
Affiliations
Review

Hypertension in Low- and Middle-Income Countries

Aletta E Schutte et al. Circ Res. .

Abstract

In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax; implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia; pooled procurement of low-cost single-pill combination therapy to improve adherence; increasing access to telehealth and mHealth (mobile health); and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.

Keywords: developing countries; diet; epidemiology; lifestyle; risk factors.

PubMed Disclaimer

Conflict of interest statement

Disclosures

None.

Figures

Figure 1.
Figure 1.
Percentage change in deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to high systolic blood pressure according to the World Bank income classification of countries between 1990 and 2019.
Figure 2.
Figure 2.
Trends in age-standardized summary exposure value of high systolic blood pressure, for the World Bank regions from 1990 to 2019.
Figure 3.
Figure 3.. Relationship between poverty and noncommunicable diseases.
Reprinted from World Health Organization with permission. Copyright © 2010, WHO.
Figure 4.
Figure 4.. Early-life effects and preventive efforts across the life course to manage raised blood pressure (BP).
CV indicates cardiovascular; and QOL, quality of life. Reprinted from Olsen et al with permission. Copyright © 2016, Elsevier, Lancet.
See this image and copyright information in PMC

References

    1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115. doi: 10.1161/HYP.0000000000000065 - DOI - PubMed
    1. Institute for Health Metrics and Evaluation (IHME). Non-communicable Diseases - Level 1 Cause. IHME, University of Washington, 2019. Accessed December 16, 2020. http://www.healthdata.org/results/gbd_summaries/2019/non-communicable-di...
    1. Institute for Health Metrics and Evaluation (IHME). Cardiovascular Diseases - Level 2 Cause. IHME, University of Washington, 2019. Accessed December 16, 2020. http://www.healthdata.org/results/gbd_summaries/2019/cardiovascular-dise...
    1. Institute for Health Metrics and Evaluation (IHME). High Systolic Blood Pressure - Level 2 Risk. IHME, University of Washington, 2019. Accessed December 16, 2020. http://www.healthdata.org/results/gbd_summaries/2019/high-systolic-blood...
    1. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, White IR, Caulfield MJ, Deanfield JE, Smeeth L, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet. 2014;383:1899–1911. doi: 10.1016/S0140-6736(14)60685-1 - DOI - PMC - PubMed

MeSH terms