The Bad News About Prevalence, the Good News About Treatments -- But Pay Attention to the Details

Linda Brookes, MSc


February 14, 2005

In This Article

Global Burden of Hypertension to Increase to 1 in 3 by 2025

By the year 2025, approximately 1 in 3 adults aged over 20 years -- 1.56 billion people worldwide -- will have hypertension, according to an analysis published in the January 15 issue of The Lancet .[1] Lead researcher Jiang He, MD, and colleagues at Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana, estimated the overall prevalence and absolute burden of hypertension in 2000 and used this to predict the future global burden. They based their calculations on data from 18 national and 12 regional multisite surveys that reported the prevalence of hypertension (defined as systolic blood pressure [SBP] ≥ 140 mm Hg, diastolic blood pressure [DBP] ≥ 90 mm Hg, or use of antihypertensive medication) between January 1, 1980, and December 31, 2002.

Population or representative data were available for 7 world regions based on the classification of the World Bank[2]: countries with established market economies; former socialist countries of Europe; Latin America, and the Caribbean; China; India; the Middle East crescent; other Asia and islands; and sub-Saharan Africa. The prevalence of hypertension in each region was calculated, and numbers from each region were added to calculate the worldwide prevalence.

Overall, 26.4% of the world's adult population in 2000 had hypertension (26.6% of men and 26.1% of women). This meant an estimated 972 million adults, broken out as 333 million in economically developed countries and 639 million in economically developing countries, in a 1:2 ratio. In men, hypertension prevalence was highest in the Latin American and Caribbean region, whereas in women it was highest in the "former socialist countries" of Europe. The lowest prevalence for both men and women was in the "other Asia and islands" region.

In general, the prevalence of hypertension at younger ages was higher in men than in women, but among older people (> 60 years) it was higher in women.

Based on the estimates for 2000, Dr. He and colleagues calculated that by 2025, the number of adults with hypertension will increase by about 60% to a total of 1.56 billion. This means that 29.2% of adults worldwide (29.0% of men and 29.5% of women) will have hypertension. Based on projected changes in age distribution, this breaks out as a 9% increase in men and a 13% increase in women. Most of this increase will occur in the economically developing regions, the researchers believe. They predict that the number of people with hypertension in these regions will increase by 80% compared with a much smaller 24% increase in the economically developed regions.

Thus, by 2025, almost three quarters of the world's hypertensive population will be in economically developing countries.

Dr. He and colleagues stress that their figures for 2025 could be an underestimate, since they were based on the assumption that country, age, and sex-specific prevalence estimates for 2000 will remain constant. However, hypertension prevalence may be increasing in some economically developed countries, as well as developing countries, the Tulane researchers note. As an example, the prevalence of hypertension in the United States based on data published in 2000 was 23.4% in the Tulane study, and the latest American Heart Association statistical update shows the prevalence of hypertension in the United States in 2002 as 32.3%.[3]


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