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-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 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% vs 67.0%), treatment (44.5% vs 55.6%), and control (17.9% vs. 28.4%) increased substantially in high-income countries, whereas awareness (32.3% vs 37.9%) and treatment (24.9% vs 29.0%) increased less, and control (8.4% vs 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.

Introduction: Hypertension is the leading preventable cause of premature death worldwide. We aimed to examine the global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compare secular changes in these disparities from 2000 to 2010. Methods: We searched MEDLINE from January 1995 to December 2014 and supplemented with manual searches of references from retrieved articles. A total of 135 population-based studies with 968,419 individuals aged ≥20 years from 90 countries were included. Sex-age-specific prevalences of hypertension from each country were applied to population data to calculate the number of hypertensive adults in each region and globally. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: An estimated 30.2% (95% confidence interval, 30.1-30.4%) of the world’s adult population in 2010 had hypertension; 28.6% (28.3-28.9%) in high-income countries and 30.3% (30.1-30.5%) in low- and middle-income countries. An estimated 1.35 billion (1.34-1.36 billion) people had hypertension in 2010; 349 million (339-359 million) in high-income and 1.00 billion (0.99-1.01 billion) in low- and middle-income countries. From 2000 to 2010, age-standardized prevalence of hypertension decreased by 2.3% in high-income countries but increased by 6.1% in low- and middle-income countries. During the same period, the proportions of awareness (56.6% vs 68.8%), treatment (42.9% vs 56.1%), and control (16.6% vs. 28.9%) increased substantially in high-income countries, whereas awareness (34.7% vs 35.1%), treatment (23.4% vs 26.4%), and control (7.0% vs 7.8%) increased only slightly in low- and middle-income countries. Conclusions: Global disparities in hypertension prevalence, awareness, treatment, and control are large and increasing. Collaborative efforts from national and international stakeholders are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Here we estimated the global prevalence and absolute burden of CKD in 2010 by pooling data from population-based studies. We searched MEDLINE (January 1990 to December 2014), International Society of Nephrology Global Outreach Program funded projects, and bibliographies of retrieved articles and selected 33 studies reporting gender- and age-specific prevalence of CKD in representative population samples. The age standardized global prevalence of CKD stages 1–5 in adults aged 20 and older was 10.4% in men (95% confidence interval 9.3–11.9%) and 11.8% in women (11.2–12.6%). This consisted of 8.6% men (7.3–9.8%) and 9.6% women (7.7–11.1%) in high-income countries, and 10.6% men (9.4–13.1%) and 12.5% women (11.8–14.0%) in low- and middle-income countries. The total number of adults with CKD was 225.7 million (205.7–257.4 million) men and 271.8 million (258.0–293.7 million) women. This consisted of 48.3 million (42.3–53.3 million) men and 61.7 million (50.4–69.9 million) women in high-income countries, and 177.4 million (159.2–215.9 million) men and 210.1 million (200.8–231.7 million) women in low- and middle-income countries. Thus, CKD is an important global-health challenge, especially in low- and middle-income countries. National and international efforts for prevention, detection, and treatment of CKD are needed to reduce its morbidity and mortality worldwide.

This study suggests that reducing SBP to levels below currently recommended targets significantly reduces the risk of cardiovascular disease and all-cause mortality. These findings support more intensive control of SBP among adults with hypertension.

B A C K G R O U N D With rapid economic development, urbanization, and an aging population, cardiovascular diseases (CVDs) have become the leading cause of death in China.O B J E C T I V E S The aim of this study was to provide a comprehensive review on the prevalence, awareness, treatment, and control of hypertension (HTN) as well as blood pressure (BP)-related morbidity and mortality of CVD in Chinese adults over time.F I N D I N G S The prevalence of HTN in China is high and increasing. Recent estimates are variable but indicate 33.6% (35.3% in men and 32% in women) or 335.8 million (178.6 million men and 157.2 million women) of the Chinese adult population had HTN in 2010, which represents a significant increase from previous surveys. BP-related CVD remains the leading cause of death in Chinese adults, with stroke being the predominant cause of cardiovascular deaths. Of those with HTN, 33.4% (30.4% in men and 36.7% in women) were aware of their condition, 23.9% (20.6% in men and 27.7% in women) were treated, and only 3.9% (3.5% in men and 4.3% in women) were controlled to the currently recommended target of BP <140/90 mm Hg. Awareness and treatment of HTN have improved over time, but HTN control has not.Geographic differences in the prevalence, awareness, treatment, and control of HTN are evident, both in terms of a north-south gradient and urban-rural disparity.C O N C L U S I O N S The prevalence of HTN is high and increasing, while the control rate is low in Chinese adults. Combatting HTN and BP-related morbidity and mortality will require a comprehensive approach at national and local levels. The major challenge moving forward is to develop and implement effective, practical, and sustainable prevention and treatment strategies in China.

IMPORTANCE After decades of decline, the US cardiovascular disease mortality rate flattened after 2010, and racial and ethnic differences in cardiovascular disease mortality persisted.OBJECTIVE To examine 20-year trends in cardiovascular risk factors in the US population by race and ethnicity and by socioeconomic status.DESIGN, SETTING, AND PARTICIPANTS A total of 50 571 participants aged 20 years or older from the 1999-2018 National Health and Nutrition Examination Surveys, a series of cross-sectional surveys in nationally representative samples of the US population, were included.EXPOSURES Calendar year, race and ethnicity, education, and family income.MAIN OUTCOMES AND MEASURES Age-and sex-adjusted means or proportions of cardiovascular risk factors and estimated 10-year risk of atherosclerotic cardiovascular disease were calculated for each of 10 two-year cycles. RESULTSThe mean age of participants ranged from 49.0 to 51.8 years and the proportion of women from 48.2% to 51.3% in the surveys. From 1999-2000 to 2017-2018, age-and sex-adjusted mean body mass index increased from 28.0 (95% CI, 27.5-28.5) to 29.8 (95% CI, 29.2-30.4); mean hemoglobin A 1c increased from 5.4% (95% CI, 5.3%-5.5%) to 5.7% (95% CI, 5.6%-5.7%) (both P < .001 for linear trends). Mean serum total cholesterol decreased from 203.3 mg/dL (95% CI, 200.9-205.8 mg/dL) to 188.5 mg/dL (95% CI, 185.2-191.9 mg/dL); prevalence of smoking decreased from 24.8% (95% CI, 21.8%-27.7%) to 18.1% (95% CI, 15.4%-20.8%) (both P < .001 for linear trends). Mean systolic blood pressure decreased from 123.5 mm Hg (95% CI, 122.2-124.8 mm Hg) in 1999-2000 to 120.5 mm Hg (95% CI, 119.6-121.3 mm Hg) in 2009-2010, then increased to 122.8 mm Hg (95% CI, 121.7-123.8 mm Hg) in 2017-2018 (P < .001 for nonlinear trend). Age-and sex-adjusted 10-year atherosclerotic cardiovascular disease risk decreased from 7.6% (95% CI, 6.9%-8.2%) in 1999-2000 to 6.5% (95% CI, 6.1%-6.8%) in 2011-2012, then did not significantly change. Age-and sex-adjusted body mass index, systolic blood pressure, and hemoglobin A 1c were consistently higher, while total cholesterol was lower in non-Hispanic Black participants compared with non-Hispanic White participants (all P < .001 for group differences). Individuals with college or higher education or high family income had consistently lower levels of cardiovascular risk factors. The mean age-and sex-adjusted 10-year risk of atherosclerotic cardiovascular disease was significantly higher in non-Hispanic Black participants compared with non-Hispanic White participants (difference, 1.4% [95% CI, 1.0%-1.7%] in 1999-2008 and 2.0% [95% CI, 1.7%-2.4%] in [2009][2010][2011][2012][2013][2014][2015][2016][2017][2018]). This difference was attenuated (-0.3% [95% CI, -0.6% to 0.1%] in 1999-2008 and 0.7% [95% CI, 0.3%-1.0%] in 2009-2018) after further adjusting for education, income, home ownership, employment, health insurance, and access to health care. CONCLUSIONS AND RELEVANCEIn this serial cross-sectional survey study that estimated US trends in cardiovascu...

Compared with the 2014 hypertension guideline, the 2017 hypertension guideline was associated with an increase in the proportion of adults recommended for antihypertensive treatment and a further reduction in major CVD events and all-cause mortality, but a possible increase in the number of adverse events in the United States.

Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. * Current affiliation: Reata Pharmaceuticals, Inc.