Modeling global 80-80-80 blood pressure targets and cardiovascular outcomes

Abstract

As the leading cause of death worldwide, cardiovascular diseases (CVDs) present major challenges for health systems. In this study, we analyzed the effects of better population blood pressure control in the context of a proposed 80-80-80 target: 80% of individuals with hypertension are screened and aware of their diagnosis; 80% of those who are aware are prescribed treatment; and 80% of those on treatment have achieved guideline-specified blood pressure targets. We developed a population CVD model using country-level evidence on CVD rates, blood pressure levels and hypertension intervention coverage. Under realistic implementation conditions, most countries could achieve 80-80-80 targets by 2040, reducing all-cause mortality by 4-7% (76-130 million deaths averted over 2022-2050) and slowing the rise in CVD expected from population growth and aging (110-200 million cases averted). Although populous middle-income countries would account for most of the reduced CVD cases and deaths, low-income countries would experience the largest reductions in disease rates.

Fig. 1. Evolution of cardiovascular health status in a cohort of at-risk adults, across three blood pressure intervention scenarios.

The probability of remaining free of hypertension, CVD or all-cause death among an example cohort of individuals aged 35–39 years in 2020 (global population, both sexes) as they age from 35–39 years in 2020 to 65–69 years in 2050.

Fig. 2. Demographic decomposition of the change in new CVD cases in three blood pressure intervention scenarios between 2020 and 2050, by country income.

The three factors that determine the change in the number of new CVD cases (y axis) are population aging, population growth and changes in age-specific CVD incidence rates. The former two are often referred to as demographic drivers; the latter is often referred to as epidemiological change. The net effect of these three factors on changes in CVD incidence is represented by the black points. LMIC, lower-middle-income countries; UMIC, upper-middle-income countries.

Fig. 3. Long-term trends in CVD-specific 50q30 from 2010 to 2050 in three blood pressure intervention scenarios, by country income.

Projections of population size and structure beyond 2019 factor in the demographic effects of excess mortality from the COVID-19 pandemic, but this does not considerably change mortality probabilities or long-term age-specific CVD death rates. LMIC, lower-middle-income countries; UMIC, upper-middle-income countries.

Fig. 4. Year by which an 80-80-80 target would be achieved in each country.

The three panels present results for the three blood pressure intervention scenarios outlined in the article.

Extended Data Fig. 1. Demographic decomposition of the change in new CVD deaths, by country income, over 2020–2050.

The results presented here are analogous to those presented in the main text but with mortality, rather than incidence, on the y axis.

Extended Data Fig. 2. Consequences of no additional action on sodium intake.

The three panels illustrate the projected year by which the 80-80-80 target for hypertension control would be achieved without co-implementation of sodium reduction policies.