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

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Anti-angiogenic and anti-metastatic activity of synthetic phosphoethanolamine.

Renal cell carcinoma (RCC) is the most common type of kidney cancer, and represents the third most common urological malignancy. Despite the advent of targeted therapies for RCC and the improvement of the lifespan of patients, its cost-effectiveness restricted the therapeutic efficacy. In a recent report, we showed that synthetic phosphoethanolamine (Pho-s) has a broad antitumor activity on a variety of tumor cells and showed potent inhibitor effects on tumor progress in vivo.We show that murine renal carcinoma (Renca) is more sensitive to Pho-s when compared to normal immortalized rat proximal tubule cells (IRPTC) and human umbilical vein endothelial cells (HUVEC). In vitro anti-angiogenic activity assays show that Pho-s inhibits endothelial cell proliferation, migration and tube formation. In addition, Pho-s has anti-proliferative effects on HUVEC by inducing a cell cycle arrest at the G2/M phase. It causes a decrease in cyclin D1 mRNA, VEGFR1 gene transcription and VEGFR1 receptor expression. Pho-s also induces nuclear fragmentation and affects the organization of the cytoskeleton through the disruption of actin filaments. Additionally, Pho-s induces apoptosis through the mitochondrial pathway. The putative therapeutic potential of Pho-s was validated in a renal carcinoma model, on which our remarkable in vivo results show that Pho-s potentially inhibits lung metastasis in nude mice, with a superior efficacy when compared to Sunitinib.Taken together, our findings provide evidence that Pho-s is a compound that potently inhibits lung metastasis, suggesting that it is a promising novel candidate drug for future developments

Inhibition of HUVEC proliferation.

<p>(a) Cell proliferation assessed by MTT assay shows that Pho-s and Sunitinib at subcytotoxic concentrations inhibit cell proliferation of HUVEC in a dose-dependent manner. Cells were labeled with CFDA and analysis was performed by flow cytometry. (b) Dot plot of untreated HUVEC reveals a cell population with a high division index (green). While treatment with 10 mM Pho-s shows a 4.5 fold reduction (*p<0.05) in that high division index of HUVEC, 1 µM Sunitinib did not showed a significant effects, observed after 96 h of treatment. (c) Histogram of treated and untreated HUVEC proliferation. Cell cycle analysis of HUVEC treated with Pho-s, Suninitib and Staurosporine (ST) (positive control of apoptosis) was performed by flow cytometry (d). Pho-s at the concentration of 10 mM arrests the cells at the G2/M phase (e), while Sunitinib at the concentrations of 1 µM inhibits the transition from the G1 to the S-phase and ST induces apoptosis recognized as the sub-G1- peak (e). The % of G2/M and G0/G1 arrests are shown in the bar diagram as mean ±SD from three independent experiments.</p

Pho-s and suninitib decrease cyclin D1 and VEGFR1 gene transcription and VEGFR1 receptor expression.

<p>(a) RT-PCR analysis of cyclin D1 demonstrated that the treatment with 10 mM Pho-s and 1 µM Suninitib reduces cyclin D1 mRNA in HUVEC. Data are expressed as fold increase versus control cells treated with PBS only and are the mean± SD of three experiments. Pho-s and Sunitinib significantly decreased VEGFR1 gene transcription (b) and (c) VEGFR1 receptor expression. The data are representative of three independent experiments performed in triplicate.</p

Lipid peroxidation and hydrogen peroxide formation.

<p>Renca cells were treated with 90 mM of Pho-s or 5 µM Sunitinib for 12 h, and then were analyzed as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057937#s2" target="_blank">Materials and Methods</a>. The detection of MDA and H₂O₂ was evaluated through the thiobarbituric acid and horseradish peroxidase assay, respectively. The data are representative of three independent experiments performed in triplicate.</p

Pho-s inhibits lung metastasis of Renca cells in BALB/c mice.

<p>(a) Schedule of treatment of Pho-s and Sunitinib. 1×10⁶ Renca cells were injected via the tail vein, and on the fourth day after the tumor implant, the treatment (i.p.) was started with Pho-s at the concentrations of 50 and 100 mg/kg/day and 10 mg/kg/day of Sunitinib and continued for 15 days. Both concentrations of Pho-s, significantly (***p<0.001) reduced both the number of lung metastasis per animal (b) and the incidence of metastasis (c), when compared to untreated mice and to treatment with Sunitinib. (d) H&E sections of lung metastasis 15 days after tumor inoculation from untreated mice and mice treated with 10 mg/kg Suntinib show the multiple metastatic foci (arrows), while in mice treated with Pho-s at both doses almost no metastatic foci can be seen. (Original magnification x20).</p

Organization of the Renca cells cytoskeleton.

<p>Immunofluorescent staining of Renca cells for the visualization of actin filaments (phalloidin, green) and nucelus (red, PI). Z-series construction of the untreated cell (a), and treated with 10 mM Pho-s for 12 h (b). Pho-s induces morphological changes in the actin cytoskeleton and induces nuclear fragmentation in Renca cells. (Original magnification x60).</p

In vitro endothelial tube formation assay employing Matrigel as a three-dimensional extracellular matrix.

<p>(a) Comparative effect of Pho-s and Sunitinib in HUVEC shows that Pho-s is much potent in mediating anti-angiogenic effects, inhibiting tube formation. Of note, the cells treated with Pho-s remain adherent in spherical clusters, lacking mature tube-like structures as observed by the SEM, while Sunitinib induces morphological changes of cells correlating with inhibition of tube formation. Quantification analysis of tube length (b) and branching points (c) show that Pho-s is effective in inhibiting crucial processes involved in angiogenesis. All conditions were assessed in triplicate, and data are expressed as mean ±SD from three independent experiments.</p

Effects of Pho-s and Sunitinib on the viability of Renca, IRPTC and HUVEC.

<p>Cells were plated at a density of 10⁴/well and treated with Pho-s (a) and Sunitinib (positive control) (b) for 24 h, and cell viability was assessed by MTT assay. Cell viability is expressed as the percentage of cells comparing the optical density (540 nm) of the treated cells with the optical density of the untreated cells. The data are representative of three independent experiments performed in triplicate.</p