Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Abstract

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.

Keywords: Awareness; Cardiovascular disease; Control; Epidemiology; Global; Hypertension; Inequity; International; Prevention; Regions; Treatment.

Figure 1

Change in absolute blood pressure control rates from 1990 to 2019 by country and sex (adapted with permission from the NCD Risk Factor Collaboration database^,). Red dots (control rates 1990), black dots (control rates 2019).

Figure 2

Global trends in hypertension-related CVD morbidity and mortality (1990–2019). Reproduced with permission: 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 3

Awareness rates of hypertension in 83 countries participating in opportunistic screening as part of the May Measurement Month campaign. Combined data for 2018 and 2019 in >2.7 million, with screenees per country ranging from 500 to 701 566. Only countries with at least 500 screenees are included.

Figure 4

Awareness, treatment, and control rates of MMM screenees defined as hypertensive (2018 and 2019). Percentage of screenees who were hypertensive: Sub-Saharan Africa: 26.6% of total (N = 370 395) screened. Americas: 40.8% of total (N = 449 117) screened *excluding the USA and Canada. Europe: 43.1% of total (N = 186 159) screened. Middle-East and North Africa: 28.3% of total (N = 139 908) screened. South and Central Asia: 31.3% of total (N = 864 394) screened. Asia Pacific: 34.1% of total (N = 1 001 001) screened.

Figure 5

The West–East divide in Europe for stroke risk. (Republished with permission from Oxford University Press on behalf of the European Society of Cardiology. Data source: Institute for Health Metric Evaluation. All rights reserved.)

Figure 6

Factors contributing to hypertension and cardiovascular disease in Asia (adapted and modified from Kario et al.).

Figure 7

Key recommendations for eliminating global inequities in hypertension care.