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Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. MethodsWe used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including

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2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

89Background: Evidence from nationally representative studies in low-and middle-income 90 countries (LMICs) on where patients are lost in the hypertension care continuum is sparse. This 91 information, however, is essential for the effective design and targeting of health services 92 interventions, and to assess progress in improving hypertension care. This study aimed to 93 determine the cascade of hypertension care in 44 LMICs -and its variation between countries 94 and population groups -by dividing the progression from need to successful treatment into 95 discrete stages and measuring the losses at each stage. 96 Methods:We pooled individual-level population-based data collected between 2005 and 2016 97 from 44 LMICs. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or 98 diastolic BP ≥90 mmHg or reporting use of medication for hypertension. Among those with 99 hypertension, we calculated the proportion who had i) ever had their BP measured, ii) been 100 diagnosed, iii) been treated, and iv) achieved control. We disaggregated the hypertension care 101 cascade by age, sex, education, household wealth quintile, body mass index, smoking status, 102 country, and region. We used linear regression to predict -separately for each cascade step -a 103 country's performance based on gross domestic product (GDP) per capita, allowing us to identify 104 countries whose performance fell outside of the 95% prediction interval. 105 Findings: 1,100,507 participants were included of whom 192,441 (17.5%) had hypertension. 106 73.6% (95% CI, 72.9 -74.3) of those with hypertension ever had their BP measured, 39.2% 107 (95% CI, 38.2 -40.3) were diagnosed, 29.9% (95% CI, 28.6 -31.3) received treatment, and 108 10.3% (95% CI, 9.6 -11.0) achieved control. Countries in Latin America and the Caribbean 109 generally achieved the highest performance, while those in sub-Saharan Africa performed worst. 110 Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on Funding: Harvard McLennan Family Fund 122 Research in context 123

Early administration of serelaxin was associated with a reduction of 180-day mortality, and this occurred with fewer signs of organ damage and more rapid relief of congestion during the first days after admission.