More than half of people with hypertension — 720 million adults worldwide — didn’t get any treatment in 2019, the study also found. Many people with hypertension — 41 percent of women and 51 percent of men — were unaware they had the condition. Even with treatment, just 23 percent of women and 18 percent of men worldwide achieved well-controlled blood pressure. “These are really alarming numbers and the only way to improve them is to measure people’s blood pressure,” says Mattias Brunström, MD, PhD, of the department of public health and clinical medicine at Umeå University in Sweden. The rise in hypertension globally is mostly due to a growing, and aging, population, says Dr. Brunström, who wasn’t involved in the study. But the surge in the number of adults with hypertension wasn’t uniform, Brunström notes. The condition became more common in many low- and middle-income countries, more than offsetting progress in reducing hypertension in many high-income countries. “Despite medical and pharmacological advances over decades, global progress in hypertension management has been slow, and the vast majority of people with hypertension remain untreated, with large disadvantages in low- and middle-income countries,” says the senior author of the study, Majid Ezzati, PhD, a global health researcher at Imperial College London. Success in diagnosing and treating hypertension in high-income countries does suggest, however, that it’s possible to improve the situation in low- and middle-income nations, Dr. Ezzati says. “Policies that enable people in the poorest countries to access healthier foods — particularly reducing salt intake and making fruit and vegetables more affordable and accessible — alongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries,” Ezzati says. For their study, Ezzati and colleagues examined data on 104 million people from 184 countries representing 99 percent of the world’s population. All the people had blood pressure measurements, and researchers defined hypertension as a systolic blood pressure of 140 millimeters of mercury (mm Hg) or greater, diastolic blood pressure of 90 mm Hg or greater, or if the person was taking medication for high blood pressure. One limitation of the study is that researchers didn’t have enough data from certain low-income countries, particularly in Oceania and sub-Saharan Africa. Another drawback was that the definition of hypertension used in the study is outdated — newer guidelines issued in 2017 call for hypertension to be diagnosed when systolic blood pressure reaches 130 mm Hg and diastolic blood pressure reaches 80 mm Hg. “The numbers would have been even more disappointing if the current criteria of 130/80 was used,” says Constantino Iadecola, MD, a neurology professor and the director and chair of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine in New York City. Under the newer treatment guidelines, systolic blood pressure of 130 mm Hg is known as stage 1 hypertension, a point when patients are advised to improve their eating and exercise habits to achieve lower blood pressure, Dr. Iadecola says. Patients may also start taking medication to lower their blood pressure at this stage if lifestyle changes don’t help people achieve optimal blood pressure control, Iadecola notes. “Often diet and exercise are sufficient, but there should be no hesitation in starting antihypertensives if there is no lowering,” Iadecola says. Expert Advice on Keeping Blood Pressure in Check For a heart-healthy diet, the American Heart Association (AHA) recommends consuming a variety of fruits, vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts, and legumes. A heart-healthy diet also limits saturated and trans fats, sodium, red meat, sweets, and sodas and other sugary drinks. Eating patterns that meet these heart-healthy criteria include the dietary approaches to stop hypertension (DASH) and Mediterranean eating plans, according to the AHA. Adults should also get at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity each week, according to exercise guidelines from the AHA. Moderate activities include a brisk walk, dancing, gardening, or a slower bike ride; vigorous workouts include running, a fast bike ride, swimming laps, and jumping rope. The U.S. Preventive Services Task Force recommends annual blood pressure screening for adults starting at age 40, or earlier for people who have a higher risk of developing hypertension, including Black individuals, people with overweight or obesity, and people who have previously had blood pressure readings that were slightly elevated but not high enough to diagnose hypertension. “It is reasonable to check blood pressure at least annually, say during your annual visit with your primary care provider,” says John William McEvoy, MBBCh, a cardiologist and a professor of preventive cardiology at the National University of Ireland in Galway and an adjunct professor at Johns Hopkins University School of Medicine in Baltimore. “And, in general, I would recommend lifestyle changes for everyone, irrespective of their blood pressure level, because the health effects of these lifestyle changes expand beyond blood pressure alone,” Dr. McEvoy says.
