Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries Marta Pereira a,b , Nuno Lunet a,b , Ana Azevedo a,b and Henrique Barros a,b Objective To systematically review quantitative differences in the prevalence, awareness, treatment and control of hypertension between developed and developing countries over the past 6 years. Methods We searched Medline [prevalence AND awareness AND treatment AND control AND (hypertension OR high blood pressure)] for population-based surveys. Prevalence, awareness, treatment and control of hypertension were compared between men and women, and between developing and developed countries, adjusting for age. The proportions of awareness, treatment and control were defined relative to the total number of hypertensive patients. Results We identified 248 articles, of which 204 did not fulfill inclusion criteria. The remaining articles reported data from 35 countries. Among men, the mean prevalence, awareness, treatment and control of hypertension were 32.2, 40.6, 29.2 and 9.8%, respectively, in developing countries and 40.8, 49.2, 29.1 and 10.8%, respectively, in developed countries. Among women, the mean prevalence, awareness, treatment and control of hypertension were 30.5, 52.7, 40.5, and 16.2%, respectively, in developing countries and 33.0, 61.7, 40.6 and 17.3%, respectively, in developed countries. After adjusting for age, the prevalence of hypertension among men was lower in developing than in developed countries (difference, S6.5%; 95% confidence interval, S11.3 to S1.8%). Conclusion There were no significant differences in mean prevalence, awareness, treatment and control of hypertension between developed and developing countries, except for a higher prevalence among men in developed countries. The prevalence, awareness, treatment and control of hypertension in developing countries are coming closer to those in developed countries. J Hypertens 27:963– 975 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Hypertension 2009, 27:963–975 Keywords: awareness, control, hypertension, prevalence, systematic review, treatment Abbreviations: BP, blood pressure; CVD, cardiovascular disease; GNP, gross national product; HT, hypertension; SBP, systolic blood pressure a Department of Hygiene and Epidemiology, Cardiovascular R&D Unit, University of Porto Medical School and b Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal Correspondence to Marta Pereira, Department of Hygiene and Epidemiology, University of Porto Medical School, Alameda Prof Herna ˆ ni Monteiro, 4200-319 Porto, Portugal Tel: +351 22 551 36 52; fax: +351 22 551 36 53; e-mail: martasfp@med.up.pt Received 9 June 2008 Revised 30 December 2008 Accepted 30 December 2008 Introduction Hypertension affects approximately one billion individ- uals worldwide [1] and is a major risk factor for coronary heart disease, heart failure, cerebrovascular disease and chronic renal failure [2–5]. The high incidence of these diseases and the high prevalence of hypertension in most societies make it the single most important cause of worldwide morbidity and mortality [6,7]. The global importance of hypertension has been increas- ingly recognized, making hypertension an essential fea- ture of current epidemiological transition. The health profiles of many developing countries are undergoing major changes [8]. Life expectancy in these countries is increasing, and people are increasingly developing diseases of old age, including hypertension and cardio- vascular diseases (CVDs) [9]. CVDs play an important role in the morbidity and mortality profiles in these societies. For example, the World Health Organization has estimated that low-income and middle-income countries contributed to 78% of CVD deaths in 1999 and that, by 2010, CVDs will be the leading cause of death in developing countries [10]. Adequate management of hypertension can effectively reduce the risks of stroke, myocardial infarction [7], chronic kidney disease [11] and heart failure [12,13]. Primary prevention of hypertension involves actions at the community level, including reducing obesity, alcohol and salt consumption and increasing physical activity [14]. Effective population control of hyper- tension demands an improvement in awareness (among both health professionals and the general population), an assessment of overall absolute CVD risk and an increase in the effectiveness of nonpharmacological and pharma- cological interventions [15]. Until the last decade, however, the worldwide picture regarding awareness, treatment and control of hypertension was far from optimal [16]. To adequately put into context the magnitude of hypertension as a public health issue, local data and Original article 963 0263-6352 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/HJH.0b013e3283282f65