title: Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.
abstract: We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.
authors.affiliation: From the Division of Health Sciences, University of Warwick Medical School, Coventry, UK (AMS, CUN); Family and Youth Health Initiative (FAYOHI), Nigeria (AMS); Department of Population Health, Luxembourg Institute of Health, Luxembourg (SS, N-BK); Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of health Sciences, University of Warwick Medical School, Coventry, UK (OAU); and Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK (OAU); Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK (N-BK).
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Sarki
authors.forename: Chidozie U
authors.initials: CU
authors.lastname: Nduka
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D059066:Gross Domestic Product; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult