Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys
Authors: Bin Zhou, Goodarz Danaei, Gretchen A Stevens, Honor Bixby, Cristina Taddei, Rodrigo M Carrillo-Larco, Bethlehem Solomon, Leanne M Riley, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodriguez-Martinez, Aubrianna Zhu, Kaveh Hajifathalian, Antoinette Amuzu, José R Banegas, James E Bennett, Christine Cameron, Yumi Cho, Janine Clarke, Cora L Craig, Juan J Cruz, Louise Gates, Simona Giampaoli, Edward W Gregg, Rebecca Hardy, Alison J Hayes, Nayu Ikeda, Rod T Jackson, Garry Jennings, Michel Joffres, Young-Ho Khang, Seppo Koskinen, Diana Kuh, Urho M Kujala, Tiina Laatikainen, Terho Lehtimäki, Esther Lopez-Garcia, Annamari Lundqvist, Stefania Maggi, Dianna J Magliano, Jim I Mann, Rachael M McLean, Scott B McLean, Jody C Miller, Karen Morgan, Hannelore K Neuhauser, Teemu J Niiranen, Marianna Noale, Kyungwon Oh, Luigi Palmieri, Francesco Panza, Winsome R Parnell, Markku Peltonen, Olli Raitakari, Fernando Rodríguez-Artalejo, Joel GR Roy, Veikko Salomaa, Giselle Sarganas, Jennifer Servais, Jonathan E Shaw, Kenji Shibuya, Vincenzo Solfrizzi, Bill Stavreski, Eng Joo Tan, Maria L Turley, Diego Vanuzzo, Eira Viikari-Juntura, Deepa Weerasekera, Majid Ezzati
Journal: The Lancet (2019)

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.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).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%.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.Wellcome Trust and WHO.