Global Hypertension 2000 to 2020: Trends, Disparities, and Progress in Awareness, Treatment, and Control

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: 1.71 billion adults with hypertension globally in 2020

• Primary Outcome: Global hypertension prevalence in 2020: 33.0% (95% CI: 32.5%-33.5%)

• Nnt Or Sensitivity: Control rates: 40.2% in high-income vs 13.6% in low-middle income countries (2020)

• Confidence Interval: 95% CI: 1.65-1.77 billion

Clinical Application

Findings support feasible public health interventions for hypertension screening and management Highly relevant to Australian practice; supports PBS subsidised antihypertensives and RACGP guidelines for cardiovascular risk assessment. Australia likely falls within high-income country category with better control rates All adult populations globally, particularly relevant for cardiovascular risk stratification

Abstract

BACKGROUND: Hypertension is the leading preventable risk factor for premature death worldwide. Accurate estimates of prevalence and control are critical for developing public health priorities. OBJECTIVE: This study sought to examine global variations in hypertension prevalence, awareness, treatment, and control by world economic region and compare secular changes from 2000 to 2020. METHODS: A systematic search of MEDLINE from January 1995 to November 2024 was supplemented with manual searches of article references. Population-based cross-sectional surveys reporting age- and sex-specific hypertension prevalence and using standardized blood pressure measurement methods were included. Sex- and age-specific prevalence by country was applied to population counts to calculate the number with hypertension regionally and worldwide. Country-specific percentages of awareness, treatment, and control were applied to numbers of adults with hypertension to obtain regional and global estimates. Hypertension was defined as mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication. RESULTS: We included 287 studies conducted in 6,060,567 adults from 119 countries. In 2020, 33.0% (95% CI: 32.5%-33.5%), or 1.71 (95% CI: 1.65-1.77) billion, of the world's adults had hypertension: 30.1% (95% CI: 29.4%-30.9%), or 395 (95% CI: 394-396) million, in high-income countries and 33.4% (95% CI: 32.8%-33.9%), or 1.32 (95% CI: 1.26-1.38) billion, in low- and middle-income countries. From 2000 to 2020, age-standardized prevalence decreased by 2.7% and absolute burden increased by 76 million in high-income countries compared with increases of 5.8% in prevalence and 651 million in absolute burden in low- and middle-income countries. From 2000 to 2020 in high-income countries, awareness increased from 57.7% to 69.2%, treatment from 42.9% to 66.3%, and control from 16.4% to 40.2%. More modest increases were observed in low- and middle-income countries: awareness from 29.1% to 46.1%, treatment from 20.7% to 30.8%, and control from 6.4% to 13.6%. CONCLUSIONS: The burden of hypertension is increasing, as are disparities between high-income countries and low- and middle-income countries. Urgent efforts are needed to address hypertension worldwide, particularly in low- and middle-income countries.

References

1. 1.O'Connell, S. S., Whelton, P. K., Li, F., Allouch, F., Shapiro, L., Vandenburg, M., Patel, M., Patel, A., Demessie, D., Blandon, H., Martin, B., Rathod, Y., Moran, A. E., Foti, K., Banigbe, B., He, H., He, J., & Mills, K. T. (2026). Global Hypertension 2000 to 2020: Trends, Disparities, and Progress in Awareness, Treatment, and Control. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2025.12.091