Hypertension - PAHO/WHO | Pan American Health Organization

ENLACE CVD BURDEN HYPERTENSION HTN:CVD EstimaTool RAISED BLOOD PRESSURE TECHNICAL NOTES ABOUT

High blood pressure, defined as systolic blood pressure (SBP) of 140 mmHg or higher or diastolic blood pressure (DBP) of 90 mmHg or higher, is one of the most important risk factors for cardiovascular diseases and chronic kidney disease. Blood pressure is a multifaceted trait, affected by nutrition, environment, and behavior throughout the life course, including fetal and early childhood nutrition and growth, adiposity, specific components of the diet, especially sodium and potassium intakes, alcohol use, smoking, physical activity, air pollution, lead, noise, psychosocial stress, and the use of blood pressure-lowering drugs.

Improving the effective coverage of treatment for patients with hypertension is an objective of many global and regional initiatives, such as HEARTS in the Americas, and national programs for hypertension prevention and control. To achieve this objective, comparable data on hypertension treatment cascade, including the prevalence of hypertension detection, treatment, and control are key to learning from good practice to guide health system programs.

This visualization presents consistent national and regional estimates of the prevalence of hypertension, detection (awareness), treatment, and control from 1990 to 2019 for the Region and 36 countries and territories of the Americas. These data allow for assessing which countries have high versus low detection, treatment, and control rates, and monitor how these metrics have changed over time.

SUMMARY OF MAIN FINDINGS

Prevalence of hypertension

In 2019, the regional age-standardized prevalence of hypertension in adults aged 30–79 was 35.4% (95% uncertainty interval [UI] 33.3–37.6) in the total population. Higher in men 37.6% (95% UI: 34.4–40.9) than in women 33.3% (95% UI: 30.4–36.3).
The regional age-standardized prevalence of hypertension in both sexes combined slightly increased by 7.6% from 32.9% (95% UI: 29.9–35.9) in 1990 to 35.4% (95% UI: 33.3–37.6), however, the trend has been stagnant since 2010. Similar trend patterns were observed in men and women respectively.
Age-standardized prevalence of hypertension in the population of both sexes combined varied across countries from a high 56.4% (95% UI: 46.6–65.9) in Paraguay to a low 20.7% (95% UI: 18.2–23.3) in Peru.
The top 20% of countries with the highest prevalence of hypertension in 2019 (≥45%) were Paraguay, Dominican Republic, Dominica, Argentina, Grenada, Jamaica, Saint Kitts and Nevis, and Brazil.
The prevalence of hypertension in 2019 was lowest in Canada and Peru for both men and women.

Prevalence of awareness (diagnosis) of hypertension

Regionally in 2019, only 69.8% (95% UI: 66.9–72.6) of people with hypertension, 75.3% (95% UI: 71.0–79.1) of women, and 64.8% (95% UI: 60.5–68.8) of men are aware of their condition.
The countries with the lowest prevalence of awareness of hypertension (lower than 60%) are Peru, Paraguay, Guatemala, Haiti, Mexico, Dominica, Argentina, and Belize.
The top three countries with the highest prevalence of awareness (≥77%) are Costa Rica, Canada, and the United States of America.

Prevalence of treatment of hypertension

In 2019, the treatment rate was 60.3% (95% UI: 57.0–63.6) in the total population, which increased by 51.1% since 1990 when the level was 39.9% (95% UI: ).
The treatment rate in 2019 was significantly higher in women, 66.7% (95% UI: 61.7–71.3) than in men, 54.4% (95% UI: 49.7–58.9).

Prevalence of hypertension control among treated

Regionwide in 2019, only 3 out of 5 people treated for hypertension achieved hypertension control, 60.4% (95% UI: 56.3–63.8).
Hypertension control among treated was slightly higher in women 61.3% (95% UI: 55.9–66.2) than in men 59.4% (95% UI: 54.1–64.3).
Prevalence of hypertension control among those treated in 2019 increased significantly by 62.8% relative to 37.1%, the level in 1990.
In 2019, the prevalence of hypertension control among treated varies across countries from 28.7% (95% UI: 20.3-36.7) in Haiti to 82.8% (95% UI: 78.5-86.3) in Canada, revealing a large gap in the health care system effectiveness among countries.

Prevalence of hypertension control in the population

In 2019, the age-standardized prevalence of hypertension control in the population was 36.4% (95% UI: 32.1–40.6), 40.9% (95% UI: 34.3–47.2) for women and 32.3% (95% UI: 26.9–37.9) for men.
The prevalence of hypertension control in the population increased by 145.9% from 1990 to 2019, 137.8% for women, and 158.4% for men.
Despite the above-mentioned progress, there are still important disparities with respect to countries that are able to reach population hypertension control over 60%.

DATA CLASSIFICATION

In the map and horizontal bar chart, the data is presented in five classes created using the quantile classification method. Each class contains 20% of countries, which is easy to interpret. The quintile intervals are labeled sequentially from Quintile 1, also called the bottom quintile which includes the lowest fifth (0 to 20%) of data points to Quintile 5 (or top quintile), which includes the top fifth (80% to 100%) of data points.

DATA SOURCES, METRICS AND METHODS

This topic and visualization used data from the WHO Global Health Observatory, Noncommunicable Diseases: Riak factors produced by the NCD Risk Factor Collaboration, which is the WHO collaborating center for the NCD risk factor estimation.

The outcome measures presented in this topic are:

the prevalence of hypertension, as the proportion of people having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension,
the proportion of people with hypertension who reported a previous hypertension diagnosis (detection or awareness),
the proportion of people with hypertension who were taking medication for hypertension (treatment), and
the proportion of people with hypertension whose blood pressure was controlled (control).

Additionally, using the above-mentioned primary metrics, we computed the following outcome measures to provide comprehensive insights into the hypertension treatment cascade:

the proportion of people with undiagnosed hypertension (unaware they have hypertension),
the proportion of people with hypertension who know they have hypertension (aware) but are untreated,
the proportion of people with hypertension who are treated but whose hypertension is uncontrolled, and
the proportion of people with controlled hypertension among those treated with blood pressure-lowering drugs.

Hypertension is defined as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. Hypertension control was defined as taking medication for hypertension and having systolic blood pressure lower than 140 mm Hg and diastolic blood pressure lower than 90 mm Hg.

The data are restricted to people aged 30–79 years because hypertension prevalence is relatively low before the age of 30 years and because guidelines differ in thresholds and treatment targets in people aged 80 years and older.

Input data and methods for the estimation of indicators of the hypertension treatment cascade are described in the following technical documents and publications:

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet; 2017.
Methodological Notes, NMH Data Portal. Pan American Health Organization. 2020.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398: 957–80.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet; 2017.
Methodological Notes, NMH Data Portal. Pan American Health Organization. 2020.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398: 957–80.

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