Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: research protocol

Abstract Aim: To determine the impact of the Best Practice Spotlight Organization® initia- tive on nurses' perception of their work environment and their attitudes to evidence- based practice. Design: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. Methods: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analy- ses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. Discussion: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. Impact: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

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.

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 Taiwan, 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, Portugal, and Taiwan. 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, Taiwan, 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. FUNDING: WHO

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

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 Taiwan, 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, Portugal, and Taiwan. 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, Taiwan, 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. Copyright (C) 2021 World Health Organization; licensee Elsevier

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

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 Taiwan, 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, Portugal, and Taiwan. 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, Taiwan, 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

Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys

Background: Describing the prevalence and trends of cardiometabolic risk factors that are associated with noncommunicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014. Methods: We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7•0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas. Findings: 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3•9% (95% CI 2•2–6•3) in 1980, to 18•6% (14•3–23•3) in 2014, in men; and from 12•2% (8•2–17•0) in 1980, to 30•5% (25•7–35•5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5•2% (2•1–10•4) in men and 6•4% (2•6–10•4) in women in 1980, to 11•1% (6•4–17•3) in men and 13•6% (8•2–21•0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27•6% (22•3–33•2) in men and 19•9% (15•8–24•4) in women in 1980, to 15•5% (11•1–20•9) in men and 10•7% (7•7–14•5) in women in 2014. Interpretation: Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries.Fil: Miranda, J. Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Carrillo-Larco, Rodrigo M.. Imperial College London; Reino UnidoFil: Ferreccio, Catterina. Pontificia Universidad Católica de Chile; ChileFil: Hambleton, Ian R.. The University Of The West Indies; BarbadosFil: Lotufo, Paulo A.. Universidade de Sao Paulo; BrasilFil: Nieto-Martinez, Ramfis. Miami Veterans Affairs Healthcare System; Estados UnidosFil: Zhou, Bin. Imperial College London; Reino UnidoFil: Bentham, James. University Of Kent; Reino UnidoFil: Bixby, Honor. Imperial College London; Reino UnidoFil: Hajifathalian, Kaveh. Cleveland Clinic; Estados UnidosFil: Lu, Yuan. University of Yale; Estados UnidosFil: Taddei, Cristina. Imperial College London; Reino UnidoFil: Abarca-Gomez, Leandra. Caja Costarricense de Seguro Social; Costa RicaFil: Acosta-Cazares, Benjamin. Instituto Mexicano del Seguro Social; MéxicoFil: Aguilar-Salinas, Carlos A.. (Instituto Nacional de Ciencias Médicas y Nutrición; MéxicoFil: Andrade, Dolores S.. Universidad de Cuenca; EcuadorFil: Assunção, Maria Cecilia F.. Universidade Federal de Pelotas; BrasilFil: Barcelo, Alberto. Pan American Health Organization; Estados UnidosFil: Barros, Aluisio J.D.. Universidade Federal de Pelotas; BrasilFil: Barros, Mauro V.G.. Universidade de Pernambuco; BrasilFil: Bata, Iqbal. Dalhousie University Halifax; CanadáFil: Batista, Rosangela L.. Universidade Federal Do Maranhao; BrasilFil: Benet, Mikhail. Cafam University Foundation; ColombiaFil: Bernabe-Ortiz, Antonio. Universidad Peruana Cayetano Heredia; PerúFil: Bettiol, Heloisa. Universidade de Sao Paulo; BrasilFil: Boggia, Jose G.. Universidad de la Republica; UruguayFil: Boissonnet, Carlos P.. Centro de Educación Médica e Investigaciones Clínicas; ArgentinaFil: Brewster, Lizzy M.. University of Amsterdam; Países BajosFil: Cameron, Christine. Canadian Fitness and Lifestyle Research Institute; CanadáFil: Cândido, Ana Paula C.. Universidade Federal de Juiz de Fora; BrasilFil: Cardoso, Viviane C.. Universidade de Sao Paulo; BrasilFil: Chan, Queenie. Imperial College London; Reino UnidoFil: Christofaro, Diego G.. Universidade Estadual Paulista; BrasilFil: Confortin, Susana C.. Universidade Federal de Santa Catarina; BrasilFil: Craig, Cora L.. Canadian Fitness and Lifestyle Research Institute; CanadáFil: d'Orsi, Eleonora. Universidade Federal de Santa Catarina; BrasilFil: Delisle, Hélène. University of Montreal; CanadáFil: De Oliveira, Paula Duarte. Universidade Federal de Pelotas; BrasilFil: Dias-da-Costa, Juvenal Soares. Universidade do Vale do Rio Dos Sinos; BrasilFil: Diaz, Alberto Alejandro. Universidad Nacional del Centro de la Provincia de Buenos Aires. Escuela Superior de Ciencias de la Salud. Instituto de Investigación en Ciencias de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Provincia de Buenos Aires. Municipalidad de Tandil. Hospital Municipal Ramón Santamarina; ArgentinaFil: Donoso, Silvana P.. Universidad de Cuenca; EcuadorFil: Elliott, Paul. Imperial College London; Reino UnidoFil: Escobedo-de La Peña, Jorge. Instituto Mexicano del Seguro Social; MéxicoFil: Ferguson, Trevor S.. The University of The West Indies; JamaicaFil: Fernandes, Romulo A.. Universidade Estadual Paulista; BrasilFil: Ferrante, Daniel. Ministerio de Salud; ArgentinaFil: Flores, Eric Monterubio. Instituto Nacional de Salud Pública; MéxicoFil: Francis, Damian K.. The University of The West Indies; JamaicaFil: Do Carmo Franco, Maria. Universidade Federal de Sao Paulo; BrasilFil: Fuchs, Flavio D.. Hospital de Clinicas de Porto Alegre; BrasilFil: Fuchs, Sandra C.. Universidade Federal do Rio Grande do Sul; BrasilFil: Goltzman, David. Université McGill; CanadáFil: Gonçalves, Helen. Universidade Federal de Pelotas; BrasilFil: Gonzalez-Rivas, Juan P.. The Andes Clinic Of Cardio-Metabolic Studies; VenezuelaFil: Gorbea, Mariano Bonet. Instituto Nacional de Higiene, Epidemiología y Microbiología; CubaFil: Gregor, Ronald D.. Dalhousie University Halifax; CanadáFil: Guerrero, Ramiro. Universidad Icesi; ColombiaFil: Guimaraes, Andre L.. Universidade Estadual de Montes Claros; BrasilFil: Gulliford, Martin C.. King’s College London; Reino UnidoFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernandez Cadena, Leticia. Instituto Nacional de Salud Pública; MéxicoFil: Herrera, Víctor M.. (Universidad Autónoma de Bucaramanga; ColombiaFil: Hopman, Wilma M.. Kingston General Hospital; CanadáFil: Horimoto, Andrea RVR. Instituto do Coração; BrasilFil: Hormiga, Claudia M.. Fundación Oftalmológica de Santander; ColombiaFil: Horta, Bernardo L.. Universidade Federal de Pelotas; BrasilFil: Howitt, Christina. The University of the West Indies; BarbadosFil: Irazola, Wilma E.. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Jiménez-Acosta, Santa Magaly. Instituto Nacional de Higiene, Epidemiología y Microbiología; CubaFil: Joffres, Michel. Simon Fraser University; CanadáFil: Kolsteren, Patricia. (Institute of Tropical Medicine; BélgicaFil: Landrove, Orlando. Ministerio de Salud Pública; CubaFil: Li, Yanping. Harvard TH Chan School of Public Health; Estados UnidosFil: Lilly, Christa L.. West Virginia University; Estados UnidosFil: Lima-Costa, M. Fernanda. Fundação Oswaldo Cruz; BrasilFil: Louzada Strufaldi, Maria Wany. Universidade Federal de Sao Paulo; BrasilFil: Machado-Coelho, George L. L.. Universidade Federal de Ouro Preto; BrasilFil: Makdisse, Marcia. Hospital Israelita Albert Einstein; BrasilFil: Margozzini, Paula. Pontificia Universidad Católica de Chile; ChileFil: Pruner Marques, Larissa. Universidade Federal de Santa Catarina; BrasilFil: Martorell, Reynaldo. Emory University; Estados UnidosFil: Mascarenhas, Luis. Universidade Federal do Paraná; BrasilFil: Matijasevich, Alicia. Universidade Federal de Sao Paulo; BrasilFil: Mc Donald Posso, Anselmo J.. Gorgas Memorial Institute of Health Studies; PanamáFil: McFarlane, Shelly R.. The University of the West Indies; JamaicaFil: McLean, Scott B.. (Statistics Canada; CanadáFil: Menezes, Ana Maria B.. Universidade Federal de Pelotas; BrasilFil: Miquel, Juan Francisco. Pontificia Universidad Católica de Chile; ChileFil: Mohanna, Salim. Universidad Peruana Cayetano Heredia; PerúFil: Monterrubio, Eric A.. Instituto Nacional de Salud Pública; MéxicoFil: Moreira, Leila B.. Universidade Federal do Rio Grande do Sul; BrasilFil: Morejon, Alain. Universidad de Ciencias Médicas; CubaFil: Motta, Jorge. Gorgas Memorial Institute of Public Health; PanamáFil: Neal, William A.. West Virginia University; Estados UnidosFil: Nervi, Flavio. Pontificia Universidad Católica de Chile; ChileFil: Noboa, Oscar A.. Universidad de la República; UruguayFil: Ochoa-Avilés, Angélica M.. Universidad de Cuenca; EcuadorFil: Olinto, Maria Teresa Anselmo. Universidad de Vale do Rio dos Sinos; BrasilFil: Oliveira, Isabel O.. Universidade Federal de Pelotas; BrasilFil: Ono, Lariane M.. Universidade Federal de Santa Catarina; BrasilFil: Ordunez, Pedro. Pan American Health Organization; Estados UnidosFil: Ortiz, Ana P.. Universidad de Puerto Rico; Puerto RicoFil: Otero, Johanna A.. Fundación Oftalmológica de Santander; ColombiaFil: Palloni, Alberto. University of Wisconsin-Madison; Estados UnidosFil: Viana Peixoto, Sergio. Fundação Oswaldo Cruz; BrasilFil: Pereira, Alexandre C.. Instituto do Coração; BrasilFil: Pérez, Cynthia M.. Universidad de Puerto Rico; Puerto RicoFil: Rangel Reina, Daniel A.. Gorgas Memorial Institute of Health Studies; PanamáFil: Ribeiro, Robespierre. Secretaria de Estado de Saúde de Minas Gerais; BrasilFil: Ritti-Dias, Raphael M.. Universidade Nove de Julho; BrasilFil: Rivera, Juan A.. Instituto Nacional de Salud Pública; MéxicoFil: Robitaille, Cynthia. Public Health Agency of Canada; CanadáFil: Rodríguez-Villamizar, Laura A.. Universidad Industrial de Santander; ColombiaFil: Rojas-Martinez, Rosalba. Instituto Nacional de Salud Pública; MéxicoFil: Roy, Joel G. R.. Statistics Canada; CanadáFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ruiz-Betancourt, Blanca Sandra. Instituto Mexicano del Seguro Social; MéxicoFil: Salazar Martinez, Eduardo. Instituto Nacional de Salud Pública; MéxicoFil: Sánchez-Abanto, José. Instituto Nacional de Salud; PerúFil: Santos , Ina S.. Universidade Federal de Pelotas; BrasilFil: dos Santos, Renata Nunes. Universidade Federal de Sao Paulo; BrasilFil: Scazufca, Marcia. Universidade Federal de Sao Paulo; BrasilFil: Schargrodsky, Herman. Hospital Italiano; ArgentinaFil: Silva, Antonio M.. Universidade Federal do Maranhao; BrasilFil: Santos Silva, Diego Augusto. Universidade Federal de Santa Catarina; BrasilFil: Stein, Aryeh D.. Emory University; Estados UnidosFil: Suárez-Medina, Ramón. Instituto Nacional de Higiene, Epidemiología y Microbiología; CubaFil: Tarqui-Mamani, Carolina B.. Instituto Nacional de Salud; PerúFil: Tulloch-Reid, Marshall K.. The University of the West Indies; JamaicaFil: Ueda, Peter. Harvard TH Chan School of Public Health; Estados UnidosFil: Ugel, Eunice E.. Universidad Centro-Occidental Lisandro Alvarado; VenezuelaFil: Valdivia, Gonzalo. Pontificia Universidad Católica de Chile; ChileFil: Varona, Patricia. Instituto Nacional de Higiene, Epidemiología y Microbiología; CubaFil: Velasquez-Melendez, Gustavo. Universidade Federal de Minas Gerais; BrasilFil: Verstraeten, Roosmarijn. Institute of Tropical Medicine; BélgicaFil: Victora, Cesar G.. Universidade Federal de Pelotas; BrasilFil: Wanderley Jr, Rildo S.. Universidade Federal de Pernambuco; BrasilFil: Wang, Ming-Dong. Public Health Agency of Canada; CanadáFil: Wilks, Rainford J.. The University of the West Indies; JamaicaFil: Wong-McClure, Roy A.. Caja Costarricense de Seguro Social; Costa RicaFil: Younger-Coleman, Novie O.. The University of the West Indies; JamaicaFil: Zuñiga Cisneros, Julio. Gorgas Memorial Institute of Public Health; PanamáFil: Danaei, Goodarz. Harvard TH Chan School of Public Health; Estados UnidosFil: Stevens, Gretchen A.. World Health Organization; SuizaFil: Riley, Leanne M.. World Health Organization; SuizaFil: Ezzati, Majid. (Imperial College London; Reino UnidoFil: Di Cesare, Mariachiara. Middlesex University; Reino Unid

Worldwide trends in blood pressure from 1975 to 2015:a pooled analysis of 1479 population-based measurement studies with 19.1 million participants

Abstract Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19.1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127.0 mm Hg (95% credible interval 125.7–128.3) in men and 122.3 mm Hg (121.0–123.6) in women; age-standardised mean diastolic blood pressure was 78.7 mm Hg (77.9–79.5) for men and 76.7 mm Hg (75.9–77.6) for women. Global age-standardised prevalence of raised blood pressure was 24.1% (21.4–27.1) in men and 20.1% (17.8–22.5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe

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

International audienceBACKGROUND - 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 Taiwan, 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, Portugal, and Taiwan. 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, Taiwan, 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

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

International audienceBACKGROUND - 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 Taiwan, 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, Portugal, and Taiwan. 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, Taiwan, 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