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He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, Dolan J, Chen CS, Gibbons L, Krousel-Wood M, Bazzano LA, Nejamis A, Gulayin P, Santero M, Augustovski F, Chen J, Rubinstein A. Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial. JAMA 2017; 318:1016-1025. [PMID: 28975305 PMCID: PMC5761321 DOI: 10.1001/jama.2017.11358] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. OBJECTIVE To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. INTERVENTIONS Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. MAIN OUTCOMES AND MEASURES The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. RESULTS Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. CONCLUSIONS AND RELEVANCE Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01834131.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jacquelyn Dolan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Analia Nejamis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Huang C, Moran AE, Coxson PG, Yang X, Liu F, Cao J, Chen K, Wang M, He J, Goldman L, Zhao D, Kinney PL, Gu D. Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China. Circulation 2017; 136:1575-1584. [PMID: 28882886 DOI: 10.1161/circulationaha.116.026487] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outdoor air pollution ranks fourth among preventable causes of China's burden of disease. We hypothesized that the magnitude of health gains from air quality improvement in urban China could compare with achieving recommended blood pressure or smoking control goals. METHODS The Cardiovascular Disease Policy Model-China projected coronary heart disease, stroke, and all-cause deaths in urban Chinese adults 35 to 84 years of age from 2017 to 2030 if recent air quality (particulate matter with aerodynamic diameter ≤2.5 µm, PM2.5) and traditional cardiovascular risk factor trends continue. We projected life-years gained if urban China were to reach 1 of 3 air quality goals: Beijing Olympic Games level (mean PM2.5, 55 μg/m3), China Class II standard (35 μg/m3), or World Health Organization standard (10 μg/m3). We compared projected air pollution reduction control benefits with potential benefits of reaching World Health Organization hypertension and tobacco control goals. RESULTS Mean PM2.5 reduction to Beijing Olympic levels by 2030 would gain ≈241,000 (95% uncertainty interval, 189 000-293 000) life-years annually. Achieving either the China Class II or World Health Organization PM2.5 standard would yield greater health benefits (992 000 [95% uncertainty interval, 790 000-1 180 000] or 1 827 000 [95% uncertainty interval, 1 481 00-2 129 000] annual life-years gained, respectively) than World Health Organization-recommended goals of 25% improvement in systolic hypertension control and 30% reduction in smoking combined (928 000 [95% uncertainty interval, 830 000-1 033 000] life-years). CONCLUSIONS Air quality improvement in different scenarios could lead to graded health benefits ranging from 241 000 life-years gained to much greater benefits equal to or greater than the combined benefits of 25% improvement in systolic hypertension control and 30% smoking reduction.
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Affiliation(s)
- Chen Huang
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Andrew E Moran
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Pamela G Coxson
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Xueli Yang
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Fangchao Liu
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Jie Cao
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Kai Chen
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Miao Wang
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Jiang He
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Lee Goldman
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Dong Zhao
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Patrick L Kinney
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.)
| | - Dongfeng Gu
- From Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing (C.H., X.Y., F.L., J.C., D.G.); National Center for Cardiovascular Diseases, Beijing, China (C.H., X.Y., F.L., J.C., D.G.); Division of General Medicine, Columbia University Medical Center, New York, New York (A.E.M.); Columbia University College of Physicians and Surgeons, New York, New York (A.E.M., L.G.); Division of General Medicine, University of California at San Francisco (P.G.C.); Helmholtz Zentrum München, German Research Center for Environmental Health (K.C.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (M.W., D.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.H.); and Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York (P.L.K.).
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Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 2016; 134:441-50. [PMID: 27502908 DOI: 10.1161/circulationaha.115.018912] [Citation(s) in RCA: 2108] [Impact Index Per Article: 263.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is the leading preventable cause of premature death worldwide. We examined global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compared secular changes from 2000 to 2010. METHODS We searched MEDLINE from 1995 through 2014 and supplemented with manual searches of retrieved article references. We included 135 population-based studies of 968 419 adults from 90 countries. Sex- and age-specific hypertension prevalences from each country were applied to population data to calculate regional and global numbers of hypertensive adults. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. RESULTS In 2010, 31.1% (95% confidence interval, 30.0%-32.2%) of the world's adults had hypertension; 28.5% (27.3%-29.7%) in high-income countries and 31.5% (30.2%-32.9%) in low- and middle-income countries. An estimated 1.39 (1.34-1.44) billion people had hypertension in 2010: 349 (337-361) million in high-income countries and 1.04 (0.99-1.09) billion in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries. During the same period, the proportions of awareness (58.2% versus 67.0%), treatment (44.5% versus 55.6%), and control (17.9% versus 28.4%) increased substantially in high-income countries, whereas awareness (32.3% versus 37.9%) and treatment (24.9% versus 29.0%) increased less, and control (8.4% versus 7.7%) even slightly decreased in low- and middle-income countries. CONCLUSIONS Global hypertension disparities are large and increasing. Collaborative efforts are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
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Affiliation(s)
- Katherine T Mills
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Joshua D Bundy
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Tanika N Kelly
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Jennifer E Reed
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Patricia M Kearney
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Kristi Reynolds
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Jing Chen
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Jiang He
- From Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., J.D.B., T.N.K., J.E.R., J.C., J.H.); Department of Epidemiology and Public Health, University College Cork, Cork, Ireland (P.M.K.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.).
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