全球非传染性疾病风险因素协作组（NCD-RisC）研究了1990-2019年全球高血压患病率趋势及治疗和控制进展。相关论文于2021年8月24日发表在《柳叶刀》杂志上。
高血压可在初级卫生保健水平检测到，低成本的治疗可有效控制高血压。该研究旨在衡量1990-2019年间200个国家和地区的高血压患病率以及高血压检测、治疗和控制方面的进展。
研究组使用了1990-2019年的数据，这些数据来自于人口代表性研究中的30-79岁人群，包括血压测量和血压治疗数据。将高血压定义为收缩压大于等于140 mm Hg，舒张压大于等于90 mm Hg，或服用高血压药物。研究组应用贝叶斯层次模型来估计高血压患病率以及先前诊断（检测）、正在服用高血压药物（治疗）以及高血压控制在140/90 mm Hg以下（对照）的高血压患者比例。该模型允许随时间变化的趋势是非线性的，并随年龄变化。
1990-2019年，30-79岁的高血压患者数量翻了一番，从1990年的331万女性和317万男性增加至2019年的626万女性和652万男性，尽管全球年龄标准化患病率保持稳定。2019年，加拿大和秘鲁的男性和女性；韩国、日本和包括瑞士、西班牙和英国在内的一些西欧国家的女性；一些中低收入国家和地区，如厄立特里亚、孟加拉国、埃塞俄比亚和所罗门群岛的男性的年龄标准化高血压患病率最低。
在中欧、东欧、中亚、大洋洲和拉丁美洲，有两个国家和地区的女性高血压患病率超过50%，有九个国家和地区的男性高血压患病率超过50%。在全球范围内，59%的女性和49%的男性高血压患者在2019年曾被诊断为高血压，47%的女性和38%的男性接受了治疗。2019年高血压患者的控制率女性患者为23%，男性为18%。
2019年，韩国、加拿大和冰岛的治疗和控制率最高（治疗率>70%；控制率>50%），其次是美国、哥斯达黎加、德国和葡萄牙。在尼泊尔、印度尼西亚以及撒哈拉以南非洲和大洋洲的一些国家，女性的治疗率不到25%，男性的治疗率不到20%，这些国家和地区的男女控制率均低于10%，北非、中亚、南亚和东欧一些国家和地区的男性控制率也低于10%。
自1990年以来，大多数国家和地区的治疗率和控制率有所提高，但研究组发现撒哈拉以南非洲和大洋洲的大多数国家和地区几乎没有变化。在高收入、中欧和一些中上收入以及最近的高收入国家和地区，包括哥斯达黎加、哈萨克斯坦、南非、巴西、智利、土耳其和伊朗，改善幅度最大。
研究结果表明，各国家和地区在高血压的检测、治疗和控制方面的改善情况大相径庭，一些中等收入国家和地区目前的表现优于大多数高收入国家和地区。不仅在高收入国家和地区，在中低收入国家和地区中，通过初级预防和加强治疗控制来降低高血压患病率的双重方法也是可行的。
附：英文原文
Title: Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants
Author: Bin Zhou, Rodrigo M Carrillo-Larco, Goodarz Danaei, Leanne M Riley, Christopher J Paciorek, Gretchen A Stevens, Edward W Gregg, James E Bennett, Bethlehem Solomon, Rosie K Singleton, Marisa K Sophiea, Maria LC Iurilli, Victor PF Lhoste, Melanie J Cowan, Stefan Savin, Mark Woodward, Yulia Balanova, Renata Cifkova, Albertino Damasceno, Paul Elliott, Farshad Farzadfar, Jiang He, Nayu Ikeda, Andre P Kengne, Young-Ho Khang, Hyeon Chang Kim, Avula Laxmaiah, Hsien-Ho Lin, Paula Margozzini Maira, J Jaime Miranda, Hannelore Neuhauser, Johan Sundstrm, Cherian Varghese, Indah S Widyahening, Tomasz Zdrojewski, Leandra Abarca-Gómez, Ziad A Abdeen, Hanan F Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J Adams, Wichai Aekplakorn, Kaosar Afsana, Shoaib Afzal, Imelda A Agdeppa, Javad Aghazadeh-Attari, Carlos A Aguilar-Salinas, Charles Agyemang, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Nastaran Ahmadi, Fariba Ahmadizar, Soheir H Ahmed, Wolfgang Ahrens, Kamel Ajlouni, Rajaa Al-Raddadi, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Mohamed M Ali, Abdullah Alkandari, Alaa Alkerwi, Kristine Allin, Eman Aly, Deepak N Amarapurkar, Norbert Amougou, Philippe Amouyel, Lars Bo Andersen, Sigmund A Anderssen, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Daniel Ansong, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E Arku, Nimmathota Arlappa, Krishna K Aryal, Thor Aspelund, Felix K Assah, Maria Cecília F Assuno, Juha Auvinen, Mária Avdiová, Ana Azevedo, Mohsen Azimi-Nezhad, Fereidoun Azizi, Mehrdad Azmin, Bontha V Babu, Suhad Bahijri, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Maja Banadinovi, Piotr Bandosz, José R Banegas, Joanna Baran, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Marta Barreto, Aluisio JD Barros, Mauro Virgílio Gomes Barros, Anna Bartosiewicz, Abdul Basit, Joao Luiz D Bastos, Iqbal Bata, Anwar M Batieha, Assembekov Batyrbek, Louise A Baur, Robert Beaglehole, Antonisamy Belavendra, Habiba Ben Romdhane, Mikhail Benet, Lowell S Benson, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloísa Bettiol, Jorge Bezerra, Aroor Bhagyalaxmi, Santosh K Bhargava, Daniel Bia, Katia Biasch, Elysée Claude Bika Lele, Mukharram M Bikbov, Bihungum Bista, Peter Bjerregaard, Espen Bjertness, Marius B Bjertness, Cecilia Bjrkelund, Katia V Bloch, Anneke Blokstra, Simona Bo, Martin Bobak, Heiner Boeing, Jose G Boggia, Carlos P Boissonnet, Stig E Bojesen, Vanina Bongard, Alice Bonilla-Vargas, Matthias Bopp, Herman Borghs, Pascal Bovet, Christopher B Boyer, Lutgart Braeckman, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp
Issue&Volume: 2021-08-24
Abstract:
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.
Methods
We 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 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, and Portugal. 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 Costa Rica, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.
Interpretation
Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.
DOI: 10.1016/S0140-6736(21)01330-1
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01330-1/fulltext
LANCET：《柳叶刀》，创刊于1823年。隶属于爱思唯尔出版社，最新IF：202.731
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