Articles

Global burden of hypertension: analysis of worldwide data

Patricia M Kearney, Megan Whelton, Kristi Reynolds, Paul Muntner, Paul K Whelton, Jiang He Lancet 2005; 365: 21723
Departments of Epidemiology
Summary (P M Kearney MD, M Whelton BS,
K Reynolds PhD, P Muntner PhD,
Background Reliable information about the prevalence of hypertension in different world regions is essential to the
Prof P K Whelton MD,
development of national and international health policies for prevention and control of this condition. We aimed to pool Prof J He MD), and Medicine
data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, (P Muntner, Prof P K Whelton,
and to estimate the global burden in 2025. Prof J He), and Tulane
Hypertension and Renal Center
of Excellence (P Munter,
Methods We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a Prof P K Whelton, Prof J He),
manual search of bibliographies of retrieved articles. We included studies that reported sex-specic and age-specic Tulane University School of
prevalence of hypertension in representative population samples. All data were obtained independently by two Public Health and Tropical
Medicine, New Orleans, LA,
investigators with a standardised protocol and data-collection form. USA; and Clinical Trial Service
Unit and Epidemiological
Results Overall, 264% (95% CI 260268%) of the adult population in 2000 had hypertension (266% of men Studies Unit, Radcliffe
[260272%] and 261% of women [255266%]), and 292% (288297%) were projected to have this condition by 2025 Inrmary, Oxford, UK
(P M Kearney)
(290% of men [286294%] and 295% of women [291299%]). The estimated total number of adults with
Correspondence to: Dr Jiang He,
hypertension in 2000 was 972 million (957987 million); 333 million (329336 million) in economically developed
Department of Epidemiology,
countries and 639 million (625654 million) in economically developing countries. The number of adults with Tulane University School of
hypertension in 2025 was predicted to increase by about 60% to a total of 156 billion (154158 billion). Public Health and Tropical
Medicine, 1430 Tulane Avenue
SL18, New Orleans, LA 70112,
Interpretation Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and USA
control of this condition should receive high priority. jhe@tulane.edu

Introduction articles. Additionally, we searched the WHO Global

Hypertension is an important worldwide public-health
challenge because of its high frequency and concomitant
risks of cardiovascular and kidney disease.1,2 It has been
identied as the leading risk factor for mortality, and is
ranked third as a cause of disability-adjusted life-years.3
The prevalence of hypertension in various regions of the
world has been widely reported;49 however, no
information has been compiled for its prevalence and
absolute burden around the world. Accurate estimates of
the worldwide prevalence of this condition are essential as
a source of primary information and for rational planning
of health services. Measurement of the global burden of
hypertension would allow international public-health
policy-makers to assign sufcient priority and resources to
its management and prevention.
National representative studies of the prevalence of this
condition have been done in some countries, whereas in
others, published data are from regional or local
population-based samples. We aimed to pool data from
population-based studies in different regions to estimate
the overall prevalence and absolute burden of
hypertension in the whole world and in various regions in
2000, and to estimate the global burden in 2025.
Methods
We searched MEDLINE using the medical subject
headings prevalence, hypertension, blood pressure,
and cross-sectional studies. The search was restricted to
studies in human beings published from Jan 1, 1980, to
Dec 31, 2002. We searched for additional studies manually
using references cited in reviews and original study
Cardiovascular InfoBase.10 Publications in another
language were translated into English. Eligibility criteria
for inclusion were: (1) population-based cross-sectional
survey in which prevalence of hypertension (or data to
calculate it) was reported; (2) methods for measurement of
blood pressure were described; (3) hypertension was
dened as an average systolic blood pressure 140 mm Hg
or greater, diastolic blood pressure 90 mm Hg or greater,
or use of antihypertensive medication; and (4) sex-specic
and age-specic prevalence of hypertension was reported.
If a national study was available for a country, we used its
data. If not, we used data from the largest and most recent
multisite or regional study. 18 national, three multisite,
and nine regional studies met the eligibility criteria and
were included in the analysis.1142 All data were extracted
independently by two of us (PMK, MW), with a
standardised protocol and data-collection form.
Countries were grouped together into world regions
according to the World Banks World Development Report
1993:43 countries with established market economies,
mainly high-income members of the Organization for
Economic Co-operation and Development; countries of
the former socialist economies of Europe; Latin America
and the Caribbean; China; India; the middle eastern
crescent; other Asia and islands; and sub-Saharan
Africa. The criteria used by the World Bank to dene
these regions include socioeconomic development,
epidemiological homogeneity, and geographical
proximity.43 For countries without valid estimates of
prevalence (n=163) or standard error, we applied data
from the country within the same world region with the

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 Articles

most similar gross national income per capita. This developing countries that reported the prevalence of
characteristic was chosen as an indicator of hypertension hypertension for the complete age range, 2080 years and
risk among countries because it is the method used by older. The goodness of t was tested by Pearsons
the World Bank to classify economies,44 and previous 2 statistic with 12 degrees of freedom, and was good (all
reviews have reported a positive association between this p values >015) except for Venezuela, where large age
value and prevalence of hypertension.45,46 groupings were used.
Not all studies provided data for the full age range under Studies that met the inclusion criteria provided
consideration (20 years and older). For each of the population data for the prevalence of hypertension for six
17 studies with missing age ranges, we did logistic of seven regions. No study from the former socialist
regression analysis using Stata47 to estimate the relation economies met all criteria for inclusion; however, a large
between age and probability of having hypertension. The population-based study from Slovakia,23 a country within
predicted probability from the model was used as an this region, reported age-specic prevalence of
estimate of the missing age-specic prevalence so that all hypertension, dened as average systolic blood pressure
age-groups of interest, from 2024 years to 80 years and 160 mm Hg or more, diastolic blood pressure 95 mm Hg
older, could contribute to the analysis. We tested the t of or more, or use of antihypertensive medication. We used a
the logistic model by applying the model to the six conversion factor derived from the English National
national studies in both economically developed and Hypertension study,15 in which estimates of hypertension
frequency were reported for both the 140/90 mm Hg and
160/95 mm Hg cutoffs, to estimate the frequency of
Year Age Study sample size (n) Blood pressure methods
range hypertension in Slovakia according to the blood pressure
(years) Device Measures/ Preparation criteria necessary for inclusion in our analysis.15 This
visits (n)
factor was applied with ratios calculated separately for
Established market economies
USA11,12 198894 18 National sample (19 661) Standard mercury 6/2 5-minute rest
men and women within each 5-year age-group.
Canada13 198692 1874 National sample (23 129) Standard mercury 4/2 5-minute rest Although no national study has investigated the
Spain14 1990 3564 National sample (2021) Random zero 3/1 .. prevalence of hypertension in India, ve regional studies
England 15
1998 20 National sample (11 529) Electronic 3/1 5-minute rest met the inclusion criteria.2428 Three rural studies were
16
Germany 199799 1879 National sample (7124) Standard mercury 3/1 5-minute rest
Greece17 1997 1891 Regional sample (665) Standard mercury 3/1 5-minute rest
initially combined, as were two urban studies, weighted
Italy18 1998 3574 National sample (8233) Standard mercury 2/1 5-minute rest by the proportion of the population of India in the region
Sweden19 1999 2574 Regional sample (1823) Standard mercury 2/1 5-minute rest of the study. The pooled urban and rural data were then
Australia20,21 1989 2564 National sample (19 315) Standard mercury 2/1 .. combined, weighted by the proportion of the total
22
Japan 1980 3074 National sample (10 346) Standard mercury* 1/1 ..
Former socialist economies
population that resides in urban and rural areas,
Slovakia23 197889 4564 Multisite sample (484 185) Standard mercury 2/1 5-minute rest respectively. Similarly in Cameroon, rural and urban
India studies were combined, weighted by the proportion of
North India rural24 199495 2170 Regional sample (2559) Random zero 3/2 5-minute rest
the total population that resides in rural and urban
North India urban251997 2564 Regional sample (1806) Standard mercury 3/1 5-minute rest
North India rural26 1997 25 Regional sample (1935) Standard mercury 1 or 2/1 5-minute rest areas.39,40
West India urban27 1995 20 Regional sample (2122) Standard mercury 2 or 3/1 5-minute rest
West India rural28 1994 20 Regional sample (3148) Standard mercury 2 or 3/1 .. Statistical analysis
Latin America and the Caribbean
The prevalence of hypertension within all selected studies
Mexico29 199293 2069 National sample (14 657) Standard mercury 1/1 5-minute rest
Paraguay30 199394 2074 National sample (9880) Aneroid 2/1 10-minute rest was standardised by age to the 1990 world population48
Venezuela31 1996 20 National sample (7424) Standard mercury 3/1 .. separately for each sex by the direct method to allow
Middle eastern crescent comparison of prevalence in individual studies.49 Crude
Egypt32 1991 2595 National sample (6733) Standard mercury 4/1 5-minute rest
prevalences of sex-specic and age-specic hypertension
Turkey33 1995 18 Regional sample (1466) Aneroid 2/1 5-minute rest
China 34
200001 3574 National sample (15 854) Standard mercury 3/1 5-minute rest for each country were applied to the WHO sex-specic and
Other Asia and islands age-specic population counts in 2000, and to projections
Korea35 1990 30 National sample (21 242) Standard mercury 2/1 5-minute rest of the expected number of adults in that country for 2025,
Thailand36 200001 35 National sample (5350) Standard mercury 3/1 5-minute rest
to estimate the number of people with hypertension in the
Taiwan37 1991 19 National sample (4894) Standard mercury 2/1 5-minute rest
Sub-Saharan Africa country for each sex and age-group in each year. The
South Africa38 1998 1565 National sample (13 802) Electronic 3/1 5-minute rest estimates for 2025 were based on the projected changes in
Cameroon39 1998 2574 Multi-site sample (1798) Standard mercury 3/1 30-minute rest size and age composition of the population, and did not
Cameroon40 1995 25 Regional sample (1467) Standard mercury 3/1 10-minute rest
Tanzania41 199697 15 Multisite sample (1698) Standard mercury 2/1 ..
include an estimate of changes in incidence of
Zimbabwe 42
1995 25 Regional sample (775) Electronic 3/1 5-minute rest hypertension. The total number of people with
hypertension in every country was estimated for men and
*Hypertension dened as average systolic blood pressure 140 mm Hg, or diastolic blood pressure 90 mm Hg. Year of
women separately. The totals from every country in a
publication of study as year of survey not given. Two blood pressure readings recorded on one day and third taken after
interval of 57 days. If blood pressure 140/90, second reading taken in lying position after 5-minute rest. Third blood region were summed to provide an estimate of the total
pressure reading recorded after 30 minutes if either of rst two was 140/90 mm Hg. number of people with hypertension in that region, and
Table 1: Characteristics of studies by world region the numbers from each region were added to obtain
worldwide counts. The prevalences of hypertension by

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region for 2000 and 2025 were calculated by dividing the Crude rate of hypertension Age-standardised rate of hypertension
total number of people with hypertension within every
Men rate (SE) Women rate (SE) Overall rate (SE) Men Women Overall
region by the total number of individuals in that region.
Established market economies
We estimated worldwide prevalence by dividing the total USA11,12 235% (12) 233% (09) 234% (09) 210% 197% 203%
number of people with hypertension worldwide by the Canada13 260% (04) 180% (04) 220% (03) 235% 156% 214%
total adult world population. SEs for the prevalences were Spain14 462% (18) 443% (14) 451% (11) 417% 390% 400%
taken from those studies that reported them. For the England15 434% (07) 350% (06) 388% (05) 347% 257% 296%
Germany 16
602% (08) 503% (08) 553% (06) 554% 566%
remaining studies, SEs were estimated as the square root Greece17 302% (28) 271% (23) 284% (17) 185% 159% 169%
of ([prevalence of hypertension(1prevalence of Italy18 448% (09) 306% (08) 377% (05) 420% 433%
hypertension)]/sample size in the survey). The SE of the Sweden19 448% (16) 320% (15) 384% (11) 396% 409%
number of people with hypertension within a region and Australia20,21 319% (05) 207% (04) 308% 201%
Japan 22
501% (03) 433% (03) 427% 350% 383%
worldwide was then estimated with Taylor series India
approximation methods. These calculations were done North India rural24 34% (06) 68% (07) 52% (05) 35% 75% 55%
separately for the populations in 2000 and 2025, and were North India urban25250% (14) 223% (14) .. 245% 232% 238%
used to provide 95% CIs. North India rural26 208% (13) 208% (13) 208% (09) 215% 249% 231%
West India urban27 300% (12) 330% (17) 309% (10) 318% 278% 307%
West India rural28 240% (10) 170% (11) 210% (07) 233% 198% 220%
Role of the funding source Latin American and the Caribbean
The sponsor of the study had no role in study design, data Mexico29 375% (06) 281% (05) 320% (04) 386% 301% 335%
collection, data analysis, data interpretation, or writing of Paraguay30 288% (05) 409% (09) 325% (05) 324% 419% 354%
Venezuela31 452% (08) 289% (07) 369% (06) 477% 322% 397%
the report. The corresponding author had full access to all Middle eastern crescent
the data in the study and had nal responsibility for the Egypt32 257% (14) 269% (12) 263% (09) 259% 293% 274%
decision to submit for publication. Turkey33 260% (15) 341% (19) 296% (12) 218% 309% 257%
China34 286% (07) 258% (07) 272% (05) 288% 266% 277%
Other Asian and islands
Results Korea 35
.. .. 198% (03) 218% 194% ..
The number of participants per study ranged from Thailand36 213% (13) 198% (10) 205% (16) 221% 214% 217
665 to 484 185 (table 1). The standard mercury sphygmo- Taiwan37 331% (07) 280% (06) 305% (05) 271% 208% 237%
Sub-Saharan Africa
manometer was the most common device used to
South Africa38 229% (06) 246% (05) 239% (07) 229% 234% 231%
measure blood pressure. Apart from three studies, blood Cameroon39 179% (14) 112% (10) 141% (17) 185% 126% 150%
pressure was measured at least twice per visit. Three Cameroon 40
142% (13) 163% (14) 154% (09)
studies measured blood pressure at two visits, and the Tanzania41 313% (17) 310% (15) 311% (11) 302% 323% 313%
Zimbabwe42 410% (25) 280% (23) 341% (17) 253% 410% 331%
remaining studies measured it on a single occasion.
Table 2 shows crude and age-adjusted prevalence of Table 2: Rate of hypertension in people aged 20 years and older in world regions
hypertension for each study; gure 1 shows the
estimated prevalence of hypertension in people aged
20 years and older for 2000 and 2025. Overall, 264%
(95% CI 260268%) of the worlds adult population in 2000
2000 had hypertension (266% in men [260272%] 50 Men
407
and 261% in women [255266%]), and 292% 40 374 372 353 391 Women
348
(288297%) were predicted to have hypertension by 30 269 283
2025 (290% in men [286294%] and 295% in 206 209 220 237 226
197
20 170
women [291299%]). Regions with the highest 145
Rate of hypertension (%)

estimated prevalence of hypertension had roughly twice 10

the rate of regions with the lowest estimated prevalence. 0
In men, the highest estimated prevalence was in the
region Latin America and the Caribbean, whereas for 2025
50 459
445
416 425 391 402
Figure 1: Frequency of hypertension in people aged 20 years and older by 40
world region and sex in 2000 (upper) and 2025 (lower)
30 270 277 270 270 282
In 2000, 95% CI by region for men and women, respectively, were: established 229 236 240
market economies (366382) (366378); former socialist economies 188 171
20
(352354) (390392); India (178234) (181236); Latin America and the
Caribbean (401-414) (343-354); middle eastern crescent (211228) 10
(229245); China (212239) (184211); other Asia and islands (161179) 0
(138153); sub-Saharan Africa (260277) (276290). In 2025, 95% CIs by
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(266288) (259280); other Asia and islands (182194) (166175);

sub-Saharan Africa (265274) (278284).

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Established Former India Latin Middle China Other Sub- Overall

market socialist America eastern Asia and Saharan
economies economies and the crescent islands Africa
Caribbean
Men, 2000
Age (years)
2029 144% 187% 85% 276% 112% 106% 111% 105% 127%
3039 212% 280% 148% 309% 141% 157% 136% 227% 184%
4049 326% 341% 248% 415% 261% 228% 178% 385% 278%
5059 448% 416% 326% 649% 372% 336% 248% 481% 390%
6069 603% 537% 399% 673% 466% 437% 308% 574% 491%
70 712% 645% 510% 729% 517% 532% 346% 585% 595%
Women, 2000
Age (years)
2029 62% 32% 71% 158% 51% 55% 72% 99% 74%
3039 99% 96% 133% 240% 120% 94% 85% 227% 126%
4049 233% 292% 234% 431% 281% 189% 150% 395% 249%
5059 420% 458% 329% 554% 483% 320% 261% 501% 391%
6069 613% 753% 422% 611% 606% 442% 314% 610% 534%
70 803% 918% 578% 700% 679% 599% 337% 623% 700%
Men, 2025
Age (years)
2029 132% 188% 85% 268% 112% 105% 111% 105% 108%
3039 199% 286% 149% 305% 144% 159% 136% 230% 171%
4049 326% 342% 249% 416% 262% 227% 178% 391% 264%
5059 450% 420% 327% 646% 373% 345% 248% 486% 361%
6069 587% 540% 399% 674% 467% 435% 309% 580% 460%
70 713% 649% 510% 729% 515% 534% 345% 588% 571%
Women, 2025
Age (years)
2029 55% 32% 72% 162% 51% 54% 71% 101% 68%
3039 91% 100% 134% 244% 121% 96% 85% 229% 124%
4049 234% 292% 234% 430% 282% 187% 153% 402% 237%
5059 424% 462% 329% 556% 486% 330% 262% 508% 370%
6069 603% 760% 423% 609% 607% 437% 314% 615% 503%
70 806% 922% 580% 691% 67.8% 599% 337% 625% 668%

Table 3: Age-specic rate of hypertension by world region

women the highest estimated prevalence was in the
former socialist economies. The lowest estimated
prevalence of hypertension for both men and women
was in the region other Asia and islands. Between
2000 and 2025, the worldwide prevalence of
hypertension was predicted to increase by 9% in men
and 13% in women because of projected changes in the
age distribution of the population. Specically, a larger
proportion of the world population is expected to be
older by 2025.
The relation between sex and prevalence of
hypertension varied by world region; four regions had
higher prevalences in men and four had higher
prevalences in women. The absolute differences
between estimated prevalences in men and women were
small; the greatest discrepancy was in Latin America
and the Caribbean, with a difference of 59%. The sex-
specic and age-specic prevalences indicate that the
overall similarity masks an interaction between sex and
age (table 3). At young ages the prevalences of
hypertension were higher in men than in women,
whereas in older people they were higher in women than
in men. Figure 2 shows estimates of the absolute
number of individuals with hypertension in different
world regions. The estimated total number of people
with hypertension in 2000 was 972 million (95% CI
957987 million); 333 million (329336 million) in
economically developed countries, and 639 million
(625654 million) in economically developing countries.
The region with the greatest estimated number of
people with hypertension was the established market
economies. However, both economically developed and
developing regions had many people with hypertension,
and about two-thirds of the total were in developing
regions. The number of adults with hypertension was
projected to increase by 60% to a total of 156 billion
(154 billion158 billion) in 2025. Most of this rise can
be attributed to an expected increase in the number of
people with hypertension in economically developing
regions. Although the number of people with
hypertension in economically developed countries was
projected to increase by 24% from 333 million to
413 million (409418 million), a rise of 80% was
predicted for economically developing countries from
639 million to 115 billion (112117 billion). On the
basis of these estimates, almost three-quarters of the
worlds hypertensive population will be in economically
developing countries by 2025.

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2000
180
160
140 1233 Men
1162
120 985 Women
Number of people with hypertension (millions)

100 831
80 604 578 600 543
60 525
406 359 379 384 330 382 416
40
20
0

2025
180 1618
160 1479 15171475
140
120 10731062 1021
985
100 804 771
80 597
722 673 621 736
60 440
40
20
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Figure 2: Number of people with hypertension aged 20 years and older by world region and sex in 2000 (upper) and 2025 (lower)
In 2000, 95% CIs by region for men and women, respectively, were: established market economies (11371187 million) (12121254 million); former socialist
economies (405408 million) (523526 million); India (522685 million) (501655 million); Latin America and the Caribbean (591609 million) (534552
million); middle eastern crescent (345373 million) (366392 million); China (9251045 million) (774889 million); other Asia and islands (363405 million)
(314346 million); sub-Saharan Africa (370394 million) (406427 million). In 2025, the 95% CIs by region for men and women, respectively, were: established
market economies (14471511 million) (15921645 million); former socialist economies (439441 million) (595598 million); India (9431202 million)
(9091216 million); Latin America and the Caribbean (10071034 million) (971998 million); middle eastern crescent (695748 million) (780829 million);
China (14421592 million) (14001550 million); other Asia and islands (639706 million) (595647 million); sub-Saharan Africa (712760 million)
(750791 million).

Discussion Thus overall, our assumption probably resulted in an

Our analysis indicates that more than a quarter of the underestimate of the true prevalence of hypertension by
worlds adult populationtotalling nearly one 2025. Finally, the methods that we used to estimate the
billionhad hypertension in 2000, and that this variance of absolute numbers and prevalence of
proportion will increase to 29%156 billionby hypertension were conservative. Therefore, the CIs could
2025. It also suggests that men and women have be smaller than those we report.
similar overall prevalence of hypertension, and that The high prevalence of hypertension worldwide has
such prevalences increase with age consistently in all contributed to the present pandemic of cardiovascular
world regions. A particularly high prevalence of disease. During the past century, such disease has
hypertension was reported in Latin America and the changed from a minor cause of death and disability to one
Caribbean, and other Asia and Islands had the lowest of the major contributors to the global burden of disease.52
prevalence. The estimates in our analysis are limited Cardiovascular diseases are now responsible for 30% of all
by several factors. In most studies, blood pressure was deaths worldwide.53,54 The rapid rise in the mortality of
measured on only one visit and the prevalence of mild cardiovascular disease over a fairly short period is
hypertension might therefore have been attributable mainly to changes in environmental risk
overestimated. factors, such as diet and physical activity.55
The projections for 2025 are based on the assumption Our ndings also indicate that hypertension is a greater
that the country, age, and sex specic prevalence estimates population burden in economically developing rather than
will remain constant. Little information is available about developed countries. Although hypertension is more
trends for the incidence and prevalence of hypertension. common in economically developed countries (373%)
Existing data suggest that the prevalence of hypertension than in economically developing ones (229%), the much
has remained stable or decreased in economically larger population of developing countries results in a
developed countries during the past decade, and has considerably larger absolute number of individuals
increased in economically developing countries.50 affected. Moreover, our projection of the number of
Furthermore, the prevalence of hypertension in some people with hypertension for 2025 is probably an
economically developed countries might be increasing.34,51 underestimate since it does not account for the rapid

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 Articles
changes in lifestyle and concurrent increase in the risk of
hypertension that is taking place in these countries.56,57 Not
only does hypertension affect more people in
economically developing than developed countries, but
onset of cardiovascular disease is also at an earlier age in
developing countries.58 In 1990, the proportion of deaths
from cardiovascular disease before age 70 years was
467% in economically developing countries compared
with 265% in developed countries.56 The magnitude of
the burden of hypertension in both developed and
developing countries contributes to predictions of a
worldwide epidemic of cardiovascular disease.59
Hypertension is important not only because of its high
frequency but also because it is a major modiable risk
factor for cardiovascular and kidney disease. However,
hypertension is only one of several proven major
modiable risk factors for cardiovascular disease.60 In
combination, these factors provide a powerful means of
predicting risk and preventing disease and death.61
A comprehensive approach is needed that focuses on
several inter-related risks to health, including
hypertension, high LDL and low HDL cholesterol
concentrations, tobacco use, high body-mass index,
physical inactivity, poor diet, and diabetes mellitus.62,63
The coordinating committee of the US National High
Blood Pressure Education Program61 has recommended a
combination of population-based and intensive targeted
strategies for primary prevention of hypertension.
Interventions that have proven effective include weight
loss, reduced intake of dietary sodium, moderate alcohol
consumption, potassium supplementation, modication
of eating habits, and increased physical activity.61 These
lifestyle changes also have a positive effect on other
cardiovascular risk factors such as obesity and type 2
diabetes mellitus. Secondary prevention efforts entail
detection, treatment, and control of hypertension.
Although improvements have been made in detection and
treatment in some countries, worldwide rates of control
remain far from adequate.50
Interventions to reduce the burden of cardiovascular
disease have been successful in Europe, North America,
Australia, and New Zealand, and have substantially
decreased age-adjusted cardiovascular mortality.64
Personal and non-personal health-service interventions
have proved cost effective at both regional and global
levels.65 Although personal health-service strategies have
greater potential to reduce the burden of disease, they are
less cost effective than population-wide ones.65 The
availability of analyses of cost-effectiveness allows key
decision-makers to establish the most appropriate
interventions with the available resources. In
economically developing regions where health-care
resources are especially scarce, investment in population-
based primary prevention strategies could yield the
greatest benet.
The magnitude of the burden of hypertension needs not
only an increase in awareness, treatment, and control of
222
For personal use. Only reproduce with permission from Elsevier Ltd.
this condition, but also concerted efforts that target
primary prevention. Changes in the lifestyles of the
general population, would result in a lower prevalence of
hypertension.
Contributors
P M Kearney, M Whelton, and K Reynolds contributed to collection,
assembly, analysis, and interpretation of data, and drafting and critical
revision of the report. P K Whelton and J He contributed to the idea for
and design of the study, analysis and interpretation of data, and drafting
and critical revision of the report. P Muntner contributed to analysis and
interpretation of data, statistical analysis, and critical revision of the report.
Conict of interest statement
We declare that we have no conict of interest.
Acknowledgments
This work was supported in part by grant R01 HL68057 from the National
Heart, Lung and Blood Institute of the National Institutes of Health, in
Bethesda, MD, USA. We would like to acknowledge Tamara Chavez-
Lindell, Andrea Montis, Olga Gurgeva, and Jorg Ruhe for translating non-
English language papers.
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