This study reviewed published studies on the prevalence of hypertension worldwide from 1980-2003. It found that the prevalence varied widely, from as low as 3.4% in rural Indian men to as high as 72.5% in Polish women. In developed countries the prevalence ranged from 20-50%, while it was generally lower in developing regions. Awareness of hypertension also varied significantly, from 25.2% in Korea to 75% in Barbados. Treatment and control of hypertension was inadequate in many areas. The study concludes that hypertension is a major public health challenge worldwide due to its high prevalence and increased risk of disease.

1. Worldwide prevalence of hypertension: a systematic review
Patricia M. Kearneya
, Megan Wheltona
, Kristi Reynoldsa
, Paul K. Wheltona,b
and Jiang Hea,b
Purpose To examine the prevalence and the level of
awareness, treatment and control of hypertension in
different world regions.
Study selection A literature search of the MEDLINE
database, using the Medical Subject Headings prevalence,
hypertension, blood pressure and cross-sectional studies,
was conducted. Published studies, which reported the
prevalence of hypertension and were conducted in
representative population samples, were included in the
review. The search was restricted to studies published
from January 1980 through July 2003.
Data extraction All data were extracted independently by
two investigators using a standardized protocol and data
collection form.
Results The reported prevalence of hypertension varied
around the world, with the lowest prevalence in rural India
(3.4% in men and 6.8% in women) and the highest
prevalence in Poland (68.9% in men and 72.5% in women).
Awareness of hypertension was reported for 46% of the
studies and varied from 25.2% in Korea to 75% in
Barbados; treatment varied from 10.7% in Mexico to 66%
in Barbados and control (blood pressure < 140/90 mmHg
while on antihypertensive medication) varied from 5.4% in
Korea to 58% in Barbados.
Conclusion Hypertension is an important public health
challenge in both economically developing and developed
countries. Significant numbers of individuals with
hypertension are unaware of their condition and, among
those with diagnosed hypertension, treatment is frequently
inadequate. Measures are required at a population level to
prevent the development of hypertension and to improve
awareness, treatment and control of hypertension in the
community. J Hypertens 22:11–19 & 2004 Lippincott
Williams & Wilkins.
Journal of Hypertension 2004, 22:11–19
Keywords: blood pressure, detection and control of hypertension, cross-
sectional studies, population, prevalence
a
Tulane University School of Public Health and Tropical Medicine, and b
Tulane
University School of Medicine, New Orleans, Louisiana, USA.
Sponsorship: This work was supported in part by grant R01HL68057 from the
National Heart, Lung and Blood Institute of the National Institutes of Health, in
Bethesda, Maryland, USA.
Correspondence and requests for reprints to Patricia M. Kearney, MBBChBAO,
MPH,Department of Epidemiology, Tulane University School of Public Health and
Tropical Medicine, 1430 Tulane Avenue SL18, New Orleans, LA 70112, USA.
Tel: +1 504 588 5165; fax: +1 504 988 1568; e-mail: pkearney@tulane.edu
Received 24 March 2003 Revised 23 May 2003
Accepted 11 September 2003
See original paper on page 21
Introduction
Hypertension is an important public health challenge
worldwide because of its high prevalence and conco-
mitant increase in risk of disease [1,2]. It is the most
important modifiable risk factor for cardiovascular,
cerebrovascular and renal disease. The comparative
Risk Assessment Collaborating Group has identified
hypertension as the leading global risk factor for
mortality and as the third leading risk factor for
disease burden [3]. While hypertension is well recog-
nized as a major cause of morbidity and mortality in
the economically developed world, the importance of
hypertension in economically developing countries is
less well established. Previous reviews have reported
on the prevalence of hypertension in different world
regions, but no study to date has assembled informa-
tion on the worldwide prevalence of hypertension [4–
6]. Quantification of the global burden of hypertension
would allow public health policy to assign sufficient
priority and resources for its management and preven-
tion.
Numerous studies have been conducted worldwide to
estimate the prevalence of hypertension. In some
countries national studies have provided estimates of
the prevalence of hypertension. In other countries and
regions, published information on the prevalence of
hypertension is sparse or does not exist. The purpose
of this review was to assemble experience from com-
munity-based studies on the prevalence of hyper-
tension in different world regions in order to estimate
the worldwide prevalence of hypertension and the
corresponding level of awareness, treatment and control
of hypertension.
Methods
A literature search of the MEDLINE database, using
the Medical Subject Headings prevalence, hyper-
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Review article 11
0263-6352 & 2004 Lippincott Williams & Wilkins DOI: 10.1097/01.hjh.0000098149.70956.79

2. tension, blood pressure and cross-sectional studies, was
conducted. The search was restricted to studies pub-
lished from January 1980 through July 2003 and con-
ducted in human subjects. A manual search for
additional studies was performed using references cited
in review and original study articles. In addition, stud-
ies were retrieved by searches of the World Health
Organization Global Cardiovascular InfoBase [7]. Non-
English language publications were translated into
English.
Two investigators independently reviewed all of the
retrieved manuscripts (P.M.K, M.W.). When there was
uncertainty or disagreement between the investigators
as to the eligibility of a study, a third investigator
(K.R.) reviewed the study to reach consensus, and,
when necessary, a majority decision was utilized. The
eligibility criteria for inclusion in the review were: (1)
population-based cross-sectional survey published after
1980, in which the prevalence of hypertension (or data
to calculate the prevalence) was reported; (2) blood
pressure measurement methods were described; and (3)
hypertension was defined as an average blood pressure
> 140/90 mmHg and/or use of antihypertensive medi-
cation. Studies conducted in convenience samples were
not included in the review. When a national study was
available for a country, data from this study were
utilized. In the absence of a national study, data from
the largest and most recent multi-site or regional study
were included.
All data were abstracted independently by two investi-
gators (P.M.K., M.W.) using a standardized protocol
and data collection form. The characteristics recorded
for each study included first author’s name, year of
publication, country of origin, survey year, sampling
methods, characteristics of the study participants (age,
sex, race), sample size, blood pressure measurement
methods (type of device, number of blood pressure
measurements), methods for preparation of study parti-
cipants for blood pressure measurement, definitions of
hypertension, awareness of hypertension, mean blood
pressure, prevalence of hypertension, and percentage of
hypertension patients who were aware of their condi-
tion and who were being treated and controlled. Where
available, the prevalence of hypertension by age group
and gender was abstracted. The age-specific data were
then age standardized for men and women separately
to the 1990 World Population [8], using the direct
method [9].
Awareness of hypertension was defined as any prior
diagnosis of hypertension by a health professional
among the population defined as having hypertension.
Treatment of hypertension was defined as use of
antihypertensive medication. Control of hypertension
was defined as the pharmacological treatment of hyper-
tension associated with systolic blood pressure , 140
mmHg and diastolic blood pressure , 90 mmHg.
Prevalence of hypertension is presented according to
eight geographic regions defined by the World Bank
[10]. These regions are: countries with established
market economies (EME), mainly consisting of high-
income Organization for Economic Cooperation and
Development members; countries of the former socia-
list economies of Europe (FSE); Latin America and the
Caribbean (LAC); China (CHN); India (IND); the
Middle Eastern crescent (MEC); other Asia and Islands
(OAI); and sub-Saharan Africa (SSA). The criteria used
by the World Bank to define these regions include:
level of socio-economic development, epidemiologic
homogeneity, and geographic proximity [10].
In total 173 studies were abstracted, of which 41 studies
[11–52], providing data on 39 countries, met the criteria
for inclusion in the primary review of hypertension
prevalence. Ten additional studies [53–62], which
provided information on changes in blood pressure over
time or on awareness, treatment and control of hyper-
tension, were included in the sections on trends in
hypertension prevalence and on hypertension aware-
ness, treatment and control status. Twenty studies were
excluded from the review only on the basis of the
definition of hypertension utilized.
Results
Prevalence of hypertension
The prevalence of hypertension in different regions
and countries is presented in Table 1. The reported
range of hypertension varied widely, with rates as low
as 3.4% in rural Indian men and as high as 72.5% in
Polish women. In economically developed countries,
the prevalence of hypertension ranged between ap-
proximately 20 and 50%. According to data from the
National Health and Nutrition Examination Survey
1999–2000, the prevalence of hypertension was 27.1%
in men and 30.1% in women in the US general adult
population. Hypertension was more prevalent in black
women than in black men, 35.8 and 30.9% respectively,
and in white women than in white men, 30.2 and
27.7%, respectively. The Canadian Heart Health Sur-
vey reported a similar prevalence of hypertension as
the National Health and Nutrition Examination Survey
(NHANES) III and estimated that 4.1 million Canadian
adults aged 18–74 years had hypertension. Many stud-
ies have estimated the prevalence of hypertension in
western Europe, although there are relatively few
national studies. The reported prevalence tends to be
higher than in equivalent studies in North America.
The Spanish National Blood Pressure Study reported a
prevalence of hypertension that increased with age and
was higher in rural (49.4%) than in urban (43.2%)
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
12 Journal of Hypertension 2004, Vol 22 No 1

3. Copyright©LippincottWilliams&Wilkins.Unauthorizedreproductionofthisarticleisprohibited.
Table 1 Prevalence of hypertension by world region
Crude prevalence Age-adjusted prevalence
Blood pressure methods of hypertension of hypertension
Study Age % No. of measures/ Men Women Total Men Women Total
Region Country Study year population range Male Device No. of visits Preparation (%) (%) (%) (%) (%) (%)
EME United States [11] 1999–2000 National sample of 5448 >18 48.0 Standard mercury 6/2 visits 5 min rest 27.1 30.1 28.7 24.2 22.4 –
Canada [12] 1986–1992 National sample of 23 129 18–74 49.2 Standard mercury 4/2 visits 5 min rest 26.0 18.0 22.0 23.5 15.6 21.4
Spain [13] 1990 National sample of 2021 35–64 – Random zero 3/1 visit – 46.2 44.3 45.1 41.7 39.0 40.0
Belgium [14] 1985–1992 Multi-site sample of 4904 25–64 52.0 Random zero 2/1 visit 5 min rest 26.7 20.0 – – – –
England [15] 1998 National sample of 11 529 >20 45.3 Electronic 3/1 visit 5 min rest 43.4 35.0 38.8 34.7 25.7 29.6
Finland [16] 1997 Multi-site sample of 5746 25–64 47.6 Standard mercury 2/1 visit 5 min rest 51.0 35.0 – – – –
Germany [17] 1997–1999 National sample of 7124 18–79 – Standard mercury 3/1 visit 5 min rest 60.2 50.3 55.3 55.4 56.6 –
Greece [18] 1997 Regional sample of 665 18–91 41.8 Standard mercury 3/1 visit 5 min rest 30.2 27.1 28.4 18.5 15.9 16.9
Italy [19] 1998 National sample of 8233 35–74 – Standard mercury 2/1 visit 5 min rest 44.8 30.6 37.7 42.0 43.3 –
Sweden [20] 1999 Regional sample of 1823 25–74 – Standard mercury 2/1 visit 5 min rest 44.8 32.0 38.4 39.6 40.9 –
Australia [21,22] 1989 National sample of 19 315 25–64 – Standard mercury 2/1 visit – 31.9 20.7 – 30.8 20.1 –
Japan [23] 1980 National sample of 10 346 30–74 44.0 Standard mercury 1/1 visit – 50.1 43.3 – 42.7 35.0 38.3
FSE Poland [24] 1987–1988 Multi-site sample of 1835 45–64 47.7 Standard mercury 2/1 visit 5 min rest 68.9 72.5 70.7 – – –
IND North India [25], Rural 1994–1995 Regional sample of 2559 21–70 48.1 Random zero 3/2 visits} 5 min rest 3.4 6.8 5.2 3.5 7.5 5.5
North India [26], Urban 1997 Regional sample of 1806 25–64 50.1 Standard mercury 3/1 visit 5 min rest 25.0 22.3 – 24.5 23.2 23.8
North India [27], Rural 1997 Regional sample of 1935 >25 50.9 Standard mercury 1 or 2/1 visit{ 5 min rest 20.8 20.8 20.8 21.5 24.9 23.1
West India [28], Urban 1995† Regional sample of 2122 >20 63.0 Standard mercury 2 or 3/1 visit 5 min rest 30.0 33.0 30.9 31.8 27.8 30.7
West India [29], Rural 1994† Regional sample of 3148 >20 64.0 Standard mercury 2 or 3/1 visit} – 24.0 17.0 21.0 23.3 19.8 22.0
LAC Barbados [30] 1996 National sample of 807 25–74 – Standard mercury 3/1 visit 10 min rest 25.4 29.6 27.9 – – –
Jamaica [30] 1996 National sample of 817 25–74 – Standard mercury 3/1 visit 10 min rest 19.0 29.2 24.7 – – –
St. Lucia [30] 1996 National sample of 1080 25–74 – Standard mercury 3/1 visit 10 min rest 24.7 28.7 26.8 – – –
Mexico [31] 1992–1993 National sample of 14 657 20–69 41.3 Standard mercury 1/1 visit 5 min rest 37.5 28.1 32.0 38.6 30.1 33.5
Paraguay [32] 1993–1994 National sample of 9880 20–74 69.8 Aneroid 2/1 visit 10 min rest 28.8 40.9 32.5 32.4 41.9 35.4
Venezuela [33] 1996 National sample of 7424 >20 49.0 Standard mercury 3/1 visit – 45.2 28.9 36.9 47.7 32.2 39.7
Cuba [34] 1994 Regional sample of 1633 >15 45.6 Standard mercury 2/1 visit 10 min rest 45.9 41.5 43.5 – – –
MEC Egypt [35] 1991 National sample of 6733 25–95 43.5 Standard mercury 4/1 visits 5 min rest 25.7 26.9 26.3 25.9 29.3 27.4
Iran [36] 1993–1994 Regional sample of 6532 >19 41.1 Standard mercury 3/1 visit 10 min rest 23.3 27.3 25.6
Turkey [37] 1995 Regional sample of 1466 >18 55.5 Aneroid 2/1 visit 5 min rest 26.0 34.1 29.6 21.8 30.9 25.7
CHN China [38] 2000–2001 National sample of 15 854 35–74 48.5 Standard mercury 3/1 visit 5 min rest 28.6 25.8 27.2 28.8 26.6 27.7
OAI Korea [39] 1990 National sample of 21 242 >30 43.7 Standard mercury 2/1 visit 5 min rest – – 19.8 21.8 19.4 –
Thailand [40] 2000–2001 National sample of 5350 >35 39.4 Standard mercury 3/1 visit 5 min rest 21.3 19.8 20.5 22.1 21.4 21.7
Singapore [41] 1998 National sample of 4723 30–69 – – 2/1 visit – 30.2 23.0 26.6 – – –
Hong Kong [42] 1995–1996 National sample of 2875 25–74 – – – – 18.3 17.4 – – – –
Kinmen [43] 1992–1994 National sample of 3826 >30 45.3 – 3/1 visit 5 min rest 43.6 32.0 37.3 4.07 34.8 –
Mauritius [44] 1992 National sample of 5160 25–74 45.8 Standard mercury 2/1 visit – 20.4 17.5 – – – –
Taiwan [45] 1991 National sample of 4894 >19 49.7 Standard mercury 2/1 visit 5 min rest 33.1 28.0 30.5 27.1 20.8 23.7
SSA South Africa [46] 1998 National sample of 13 802 15–65 41.6 Electronic 3/1 visit 5 min rest 22.9 24.6 23.9 22.9 23.4 23.1
Cameroon [47] 1998† Multi-site sample of 1798 25–74 42.8 Standard mercury 3/1 visit 30 min rest 17.9 11.2 14.1 18.5 12.6 15.0
Cameroon [48] 1995 Regional sample of 1467 >25 45.7 Standard mercury 3/1 visit 10 min rest 14.2 16.3 15.4 – – –
Tanzania [49] 1996–1997 Multi-site sample of 1698 >15 – Standard mercury 2/1 visit – 31.3 31.0 31.1 30.2 32.3 31.3
Zimbabwe [50] 1995 Regional sample of 775 >25 49.5 Electronic 3/1 visit 5 min rest 41.0 28.0 34.1 25.3 41.0 33.1
Nigeria [48] 1995 Multi-site sample of 2509 >25 46.7 Standard mercury 3/1 visit 10 min rest 14.7 14.3 14.5 – – –
Senegal [51] 1992 Regional sample of 2300 15–99 45.3 Standard mercury 2/1 visit 5 min rest 23.6 21.5 22.4 27.8 31.3 29.4
Gambia [52] 1997† National sample of 6021 >15 44.8 Electronic 1 or 2/1 or 2 visits# – – – 24.2 – – –
In the absence of age-specific rates, only crude rates were available, and this is indicated in the table by the presence of dashes. ÃHypertension defined as average blood pressure (BP) >140/90 mmHg. All other studies
defined hypertension as average BP >140/90 mmHg and/or use of antihypertensive medication. †Year of publication of study as year of survey not described. {If BP >140/90 mmHg, a second reading was taken in the lying
position after a 5 min rest. }Two BP readings were recorded on a single day and a third reading was taken after an interval of 5–7 days. }Third BP was recorded after 30 min if either of first two readings >140/90 mmHg. #All
persons with diastolic BP (DBP) . 90 mmHg were asked to return for a second measurement; where two measurements were available, the lowest reading was used for analysis.
WorldwideprevalenceofhypertensionKearneyetal.13

4. dwellers. The study estimated that there were 6 million
hypertensives aged 35–64 years in Spain.
No national studies on the prevalence of hypertension
have been conducted to date in the Former Socialist
Economies. The largest and most recent regional popu-
lation-based study is the Pol-Monica Project, which was
conducted in Warsaw (urban) and Tarnobrzeg Province
(semi-rural) in 1987–1989. There were no urban–rural
differences in hypertension prevalence among Polish
men or women. The reported prevalence of hyper-
tension (70.7%) was much higher than in any other
study included in the review.
Several regional studies have been conducted in differ-
ent parts of India but no national studies have been
performed. While the prevalence of hypertension was
approximately 5% in one rural study, the prevalence in
most of the studies was between 20 and 30%. Similarly,
the combined prevalence of hypertension in three
countries in the Caribbean was estimated as 26.6%.
Three national studies from Latin America have esti-
mated that hypertension affected approximately one-
third of their populations. In Paraguay, hypertension
was more prevalent in metropolitan than in rural areas.
A study in Cienfuegos, Cuba reported a higher pre-
valence of hypertension among blacks than whites (46
versus 43%, respectively). However the magnitude of
the black and white difference was relatively smaller
than that observed in the US.
The Egyptian National Hypertension Project reported
regional variations in hypertension rates, with preva-
lence less than 20% in two regions and close to 30% in
the other four regions. A study in Isfahan, Iran reported
a higher prevalence of hypertension in urban women
(29.0%) than urban men (24.0%), while rural women
(10.0%) had a lower prevalence than rural men (13.0%).
Data from InterASIA, the most recent Chinese national
study, estimated that 129 824 000 Chinese persons aged
35–74 had hypertension. The prevalence of hyper-
tension was higher in north compared to south China,
for both men and women. The age-specific prevalence
of hypertension was similar in rural and urban residents.
The prevalence of hypertension in Korea varied by
region and was lowest in rural areas and highest in
urban areas. A recently completed study estimated that
5.1 million of the adult population aged 35 years and
older in Thailand had hypertension. The prevalence of
hypertension was greater among urban (26.0%) than
rural populations (18.0%). In Singapore, the second
National Health Survey was conducted in a representa-
tive group of Chinese, Malay and Indian residents.
Malays had the highest prevalence of hypertension
(32.3%), followed by Chinese with 26.0% and Indians
with 23.7%.
The prevalence of hypertension in South Africa was
estimated in the Demographic and Health Survey in
1998. The overall prevalence was similar in men and
women. However, white (33.5%) and Asian/Indian
(28%) men had higher rates than white (23.3%) and
Asian/Indian (25.3%) women, while African (23.5%)
and colored (27.3%) men had lower prevalence rates
than African (25%) and colored (29.6%) women. A
multi-site study conducted in Cameroon reported a
prevalence of hypertension that was slightly higher in
urban (15.9%) than in rural areas (11.7%). A study in
Tanzania found a similar prevalence of hypertension in
urban and rural residents, 29.2 and 31.8%, respectively.
The highest prevalence of hypertension in Sub-Saharan
Africa was reported in a study from urban Zimbabwe
with rates as high or higher than those in economically
developed countries.
Trends in the prevalence of hypertension
In some countries, surveys have been repeated over
time or different surveys have been conducted at
different time points, allowing an estimate of changes
in the prevalence of hypertension over time (Table 2).
The prevalence of hypertension in the US declined
uniformly across all population groups between
NHANES I and II, with an additional and greater
decline between NHANES II and the first two phases
of NHANES III. However, the most recent NHANES
survey reported an increase in the prevalence of hyper-
tension. The Health Survey for England was conducted
in 1998 and updated the findings of a previous survey
in 1994. The prevalence of hypertension in those aged
16 years and older was similar in both surveys, 37% in
1998 and 38% in 1994. The Monitoring Trends and
Determinants in Cardiovascular Disease (MONICA)
studies have been conducted in a number of European
countries over the past two decades. Comparison of the
results from the Belgian component of MONICA
(1985–1992) with the earlier Belgian Inter-university
Research on Nutrition and Health project, BIRNH
(1980–1984), demonstrated a significant decline in the
prevalence of hypertension, from 41 and 30.5% to 26.7
and 20% in men and women, respectively. As part of
FINMONICA, four independent cross-sectional sur-
veys were conducted in 1982, 1987, 1992 and 1997.
The prevalence of hypertension remained stable be-
tween 1982 and 1987. There was a significant down-
ward trend in the prevalence of hypertension during
1987–1992. During 1992–1997, mean diastolic blood
pressure remained unchanged but mean systolic blood
pressure decreased. In Germany, the MONICA Augs-
burg Project studied the prevalence of hypertension
with three cross-sectional surveys in 1984–1985, 1989–
1990 and 1994–1995. In contrast with the Belgian and
Finnish studies, the age-standardized prevalence of
hypertension increased slightly from the first to the
third survey. In Greece, a 1997 survey reported a
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
14 Journal of Hypertension 2004, Vol 22 No 1

5. prevalence of hypertension that was very similar to a
much earlier study in Athens conducted between 1979
and 1983. The prevalence of hypertension in the
Australian general population was estimated as part of
the National Heart Foundation’s Risk Factor Preva-
lence Study, with surveys administered in 1980, 1983
and 1989. There was a significant reduction in the
proportion of the survey participants who were classi-
fied as hypertensive during the 1980s. The prevalence
of hypertension decreased from 45.6 and 30.4% in 1980
to 35.1 and 24.0% in 1983 in men and women,
respectively; the prevalence decreased further between
1983 and 1989.
The third Chinese national hypertension survey re-
ported an increase in the prevalence of hypertension of
approximately 25% between 1979 and 1991. The
results of InterASIA indicated that the prevalence of
hypertension had increased by a further 42% in men
and 35% in women during the past decade. In Singa-
pore, the prevalence of hypertension increased from
22.5% in 1992 to 26.6% in 1998, despite the implemen-
tation of a national intervention program. The preva-
lence of hypertension in Mauritius decreased between
1987 and 1992; the decrease in prevalence was popu-
lation-wide and occurred in all ethnic groups and most
age groups. The 1992 survey was conducted following
5 years of a non-communicable disease intervention
program. A meta-analysis of hypertension prevalence
rates in India published in 1996 demonstrated a signifi-
cant increase in the prevalence of hypertension. The
increase was significantly higher in urban than in rural
populations and the prevalence of hypertension was
higher in urban compared to rural areas.
Awareness, treatment and control of hypertension
The level of awareness, treatment and control of hyper-
tension varied considerably between countries and
regions (Table 3). In economically developed countries,
there were relatively high levels of awareness and
treatment, with approximately one-half to two-thirds of
hypertensives aware of their diagnosis and one-third to
one-half receiving treatment. With the exception of
Spain, where only 15.5% of treated hypertensives had
their blood pressure under control, the levels of control
among treated hypertensives ranged from approxi-
mately 30 to 50%. While the levels of awareness,
treatment and control in most economically developing
countries tended to be lower than those reported in
economically developed countries, the differences were
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Table 2 Trends in the prevalence of hypertension
Hypertension prevalence (%)
Region Country Study Year Men Women Overall
EME USA NHANES I 1971–1974 40.7 32.1 36.3
NHANES II 1976–1980 36.8 27.2 31.8
NHANES III
Phase 1 1989–1991 24.9 24.5 25.0
Phase 2 1991–1994 23.9 26.0 25.0
NHANES 1999–2000 1999–2000 27.1 30.1 28.7
England Health Survey for England 1994 – – 38.0
Health Survey for England 1998 41.5 33.3 37.0
Belgium BIRNH 1980–1985 41.0 30.5 –
MONICA 1985–1992 26.7 20.0 –
Finland FINMONICA 1982 60.7 42.2 –
FINMONICA 1987 60.5 39.2 –
FINMONICA 1992 48.3 31.7 –
FINMONICA 1997 45.9 29.6 –
Germany MONICA Augsburg 1984–1985 37.8 24.6 –
MONICA Augsburg 1989–1990 37.7 23.5 –
MONICA Augsburg 1994–1995 39.3 24.8 –
Greece Athens 1979-1983 31.0 27.7 –
Didima 1997 30.2 27.1 28.4
Australia Risk Factor Prevalence Study 1980 45.6 30.4 –
Risk Factor Prevalence Study 1983 35.1 24.0 –
Risk Factor Prevalence Study 1989 31.9 20.7 –
CHN China Second National High Blood Pressure Survey 1979–1980 – – 7.8
Third National High Blood Pressure Survey 1991 – – 11.4
InterASIA 2000–2001 28.6 25.8 27.2
OAI Mauritius Survey of Non-Communicable Disease Risk
Factors
1987 26.0 21.1 –
Survey of Non-Communicable Disease Risk
Factors
1992 20.4 17.5 –
Singapore First National Health Survey 1992 26.2 18.7 22.5
Second National Health Survey 1998 30.2 23.0 26.6
NHANES, National Health and Nutrition Examination Survey; BIRNH, Belgian Inter-university Research on Nutrition and Health project; MONICA,
Monitoring Trends and Determinants in Cardiovascular Disease.
Worldwide prevalence of hypertension Kearney et al. 15

6. minimal. In fact, the highest levels of awareness,
treatment and control were reported from the Carib-
bean. In the other economically developing countries,
approximately one-quarter to one-half of hypertensives
were aware of their diagnosis, between 10 and 50%
were receiving treatment, and the proportion of treated
hypertensives under control ranged from approximately
20 to 50%.
Trends in the level of awareness, treatment and control
During the 12-year interval between NHANES II and
III, the proportion of hypertensive patients who were
aware of their condition increased from 51 to 73%.
Increases in awareness were greater for whites than for
blacks. Awareness was higher for women than men
among both blacks and whites. The overall percentage
of treated hypertensives with controlled blood pressure
increased from 32% in 1976–1980 to 55% in 1988–1991
in the US general population. In 1999–2000, 68.9% of
all hypertensives were aware of their hypertension,
58.4% were receiving treatment and, among all hyper-
tensives, control was achieved in only 31%. Awareness
remained unchanged from 1988 to 2000, although
treatment and overall control increased by 6 and 6.4%,
respectively. The most recent European national study,
the Health Survey for England, reported increased
hypertension awareness, treatment and control from
46.0, 31.6 and 7.1% in 1994 to 52.2, 38.0 and 10.7% in
1998. In Germany, from 1984/85 to 1994/95 awareness
remained at approximately 50% in men and 60% in
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Table 3 Awareness, treatment and control of hypertension by world region
Hypertensives
Treated
hypertensives
Region Country Study year Age range Aware (%) Treated (%) Controlled (%) Controlled (%)
EME United States 1999–2000 18–80+ Men 66.3 54.3 32.6 59.9
Women 71.2 62.0 29.6 47.8
Total 68.9 58.4 31.0 53.1
Canada 1986–1992 18–74 Men 53.0 32.0 13.0 40.6
Women 65.0 49.0 20.0 40.8
Total 58.0 39.0 16.0 41.0
Spain 1990 35–64 Men 39.8 27.5 3.7 13.6
Women 47.7 35.0 5.8 16.5
Total 44.5 32.0 5.0 15.5
England 1998 16–75 Men 40.3 25.7 8.0 31.1
Women 52.2 38.0 10.7 28.2
Total 46.2 31.8 9.3 29.2
Germany 1994–1995 25–74 Men 53.8 29.0 9.5 32.8
Women 67.3 43.4 14.9 34.3
Total 59.5 35.1 11.8 33.6
Greece 1997 18–90 Men 50.0 45.2 22.6 50.0
Women 69.5 61.9 30.5 49.3
Total 60.8 54.5 27.0 49.5
Japan 1980 30–74 Men – 40.5 23.6 55.7
Women – 54.5 36.0 65.4
LAC Barbados 1996 25–74 Total 75.0 66.0 38.0 58.0
Jamaica 1996 25—74 Total 67.0 44.0 24.0 55.0
St. Lucia 1996 25—74 Total 55.0 40.0 13.0 33.0
Mexico 1992–1993 20–69 Men 17.3 6.5 1.1 16.2
Women 38.4 14.6 3.5 24.1
Total 28.2 10.7 2.3 21.8
Venezuela 1996 20+ Men – 13.1 6.2 47.3
Women – 26.0 3.3 12.7
Total 45.7 22.9 4.5 19.7
Cuba 1998Ã 15+ Men – 36.4 11.8 32.2
Women – 51.6 18.3 35.4
Total – 44.3 15.2 34.1
MEC Egypt 1991 25–95 Men 28.0 – 10.9 –
Women 46.3 – 4.8 –
Total 37.5 23.9 8.0 33.5
Turkey 1995 18+ Men 45.7 35.4 9.4 26.6
Women 69.5 59.2 9.4 15.9
Total 57.9 47.6 9.4 19.8
CHN China 2000–2001 35–74 Men 39.5 23.5 6.1 26.1
Women 50.8 33.8 10.5 31.0
Total 44.7 28.2 8.1 28.8
OAI Korea 1990 30–70+ Total 25.2 15.9 0.9 5.4
Taiwan 1993–1996 19+ Men 22.0 13.0 2.0 18.0
Women 39.0 28.0 5.0 18.0
SSA South Africa 1998 15–65 Men 26.0 21.0 10.0 47.6
Women 51.0 36.0 18.0 50.0
16 Journal of Hypertension 2004, Vol 22 No 1

7. women. The proportion of hypertensives receiving drug
treatment increased by 7.9% in men and 4.1% in
women.
Trends in awareness, treatment and control of hyper-
tension have also been reported in economically devel-
oping countries. Rates of awareness, treatment and
control improved significantly in the decade between
the 1991 Chinese National Hypertension Survey and
InterASIA. Awareness of hypertension increased from
26.3 to 44.7%, treatment from 12.1 to 28.2% and control
from 2.8 to 8.1%.
Discussion
Hypertension is an important public health problem in
both the economically developed and developing
world. The data in our review provide estimates of the
burden of hypertension in different countries and in
different world regions. Only studies which defined
hypertension as an average blood pressure > 140/90
mmHg and/or use of antihypertensive medication were
included in the review. This choice was made to allow
valid comparisons of studies from different countries
and regions. Variations in the blood pressure measure-
ment methodology, age range of study participants and
the standard population chosen for age adjustment
made direct comparisons of the studies difficult. The
age-adjusted rates provide the best estimates for com-
parisons between studies with similar age ranges. The
age range of the Polish study was particularly narrow
(45–64 years), which may explain in part the high
prevalence rates observed. While there was a wide
range in the prevalence of hypertension around the
world, the overall results were surprisingly consistent.
Using criteria from the Seventh Report of the Joint
National Committee on Prevention, Detection, Evalua-
tion, and Treatment of High Blood Pressure, (JNC VII)
[63], the worldwide prevalence of hypertension in the
adult population has previously been estimated to be
approximately 20% [64]. Our review provides data that
in most countries and world regions, between one-
quarter and one-third of the population, both men and
women, have elevated blood pressure. Over the past
decade, the prevalence of hypertension remained stable
or decreased in economically developed countries and
increased in economically developing countries. The
pattern of results suggests that the most reliable
estimate of the prevalence of hypertension to be
approximately 30%
The distribution of hypertension in populations is influ-
enced by a number of factors. The prevalence of
hypertension varies by age, gender and racial composi-
tion of the population under study. The age range of
the studies in our review varied and provides a guide to
the comparability of the studies. In most studies, data
were reported by gender, and hypertension tended to
occur more frequently in men than in women. In some
studies, the results were reported separately by race
and, where available, this has been described. The
effect of race on the prevalence of hypertension
differed by sex and by study country, so that no clear
effect of race on the prevalence of hypertension
emerged. In the US, and to a lesser extent in Cuba,
hypertension was more prevalent in blacks than whites
[11,34]. However, in South Africa hypertension was
more prevalent in white men than African or colored
men, but was more prevalent in African and colored
women than white women [46].
The levels of awareness, treatment and control of
hypertension vary between countries. Hypertension
control rates also vary within countries by age, gender,
race/ethnicity, socio-economic status, education and
quality of health care [65]. Awareness of hypertension
has improved in the US and other Western countries
over the past decade, but remains inadequate, in
particular as only a proportion of those who are aware
of their diagnosis are treated, and an even smaller
number of those receiving treatment are treated ade-
quately. The levels of awareness, treatment and control
of hypertension are particularly low in some economic-
ally developing countries.
Contrary to the concept that individual major risk
factors for coronary heart disease (CHD) are absent in
many patients with CHD, two recent analyses have
confirmed the importance of the conventional risk
factors: hypertension, smoking, diabetes mellitus and
hyperlipidemia [66,67]. The analyses demonstrated that
most coronary heart disease occurs in individuals with
at least one of these risk factors [66,67]. The Global
Burden of Disease study estimated the potential bene-
fits of reducing major risk factors and identified hyper-
tension as the leading risk factor for mortality and the
third leading risk factor for disease burden [3]. In
combination with our review, these studies reinforce
the importance of hypertension and the lifestyle beha-
viors that cause it.
An acknowledgement of the global nature of the
problem of hypertension is required so that health-care
providers screen for, and treat, elevated blood pressure.
However, the magnitude of the burden of hypertension
requires not only an increase in the awareness, treat-
ment and control of hypertension, but also concerted
efforts targeting the primary prevention of hyper-
tension. A reduction in average blood pressure could be
achieved by lifestyle modification of the population,
which would result in a reduced prevalence of hyper-
tension. The United States National High Blood Pres-
sure Education Program Coordinating Committee has
recommended six approaches with proven efficacy for
the primary prevention of hypertension [68]. These
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Worldwide prevalence of hypertension Kearney et al. 17

8. interventions include weight loss, dietary sodium re-
duction, moderation in alcohol consumption, increased
physical activity, potassium supplementation and mod-
ification of whole diets [68]. The data from this review
emphasize the global nature of the problem of hyper-
tension and should provide an impetus for population-
level approaches to its prevention and treatment.
Acknowledgements
The authors would like to acknowledge Ms Tamara
Chavez-Lindell, Ms Andrea Montis, Dr Olga Gurgeva
and Dr Jorg Ruhe for their contributions to this project
by translating non-English language papers.
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