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.</p

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

Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.</jats:p

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Parallel and successive resource allocation for V2V communications in overlapping clusters

\u3cp\u3eThe 3rd Generation Partnership Project (3GPP) has introduced in Rel. 14 a novel technology referred to as vehicle-to-vehicle (V2V) mode-3. Under this scheme, the eNodeB assists in the resource allocation process allotting sidelink subchannels to vehicles. Thereupon, vehicles transmit their signals in a broadcast manner without the intervention of the former one. eNodeBs will thereby play a determinative role in the assignment of sub-channels as they can effectively manage V2V traffic and prevent allocation conflicts. The latter is a crucial aspect to enforce in order for the signals to be received reliably by other vehicles. To this purpose, we propose two resource allocation schemes namely bipartite graph matching-based successive allocation (BGM-SA) and bipartite graph matching-based parallel allocation (BGM-PA) which are suboptimal approaches with lesser complexity than exhaustive search. Both schemes incorporate additional constraints to prevent allocation conflicts from emerging. In this research, we consider overlapping clusters only, which could be formed at intersections or merging highways. We show through simulations that BGM-SA can attain near-optimal performance whereas BGM-PA is subpar but less complex. Additionally, since BGM-PA is based on inter-cluster vehicle pre-grouping, we explore different metrics that could effectively portray the overall channel conditions of pre-grouped vehicles. This is of course not optimal in terms of maximizing the system capacity - since the allocation process would be based on simplified surrogate information - but it reduces the computational complexity.\u3c/p\u3

Network-assisted resource allocation with quality and conflict constraints for V2V communications

The 3rd Generation Partnership Project (3GPP) has recently established in Rel. 14 a network-assisted resource allocation scheme for vehicular broadcast communications. Such novel paradigm is known as vehicle--to--vehicle (V2V) \textit{mode-3} and consists in eNodeBs engaging only in the distribution of sidelink subchannels among vehicles in coverage. Thereupon, without further intervention of the former, vehicles will broadcast their respective signals directly to their counterparts. Because the allotment of subchannels takes place intermittently to reduce signaling, it must primarily be conflict-free in order not to jeopardize the reception of signals. We have identified four pivotal types of allocation requirements that must be guaranteed: one quality of service (QoS) requirement and three conflict conditions which must be precluded in order to preserve reception reliability. The underlying problem is formulated as a maximization of the system sum-capacity with four types of constraints that must be enforced. In addition, we propose a three-stage suboptimal approach that is cast as multiple independent knapsack problems (MIKPs). We compare the two approaches through simulations and show that the latter formulation can attain acceptable performance at lesser complexity

TDOA-based localization via stochastic gradient descent variants

Source localization is of pivotal importance in several areas such as wireless sensor networks and Internet of Things (IoT), where the location information can be used for a variety of purposes, e.g. surveillance, monitoring, tracking, etc. Time Difference of Arrival (TDOA) is one of the well-known localization approaches where the source broadcasts a signal and a number of receivers record the arriving time of the transmitted signal. By means of computing the time difference from various receivers, the source location can be estimated. On the other hand, in the recent few years novel optimization algorithms have appeared in the literature for $(i)$ processing big data and for $(ii)$ training deep neural networks. Most of these techniques are enhanced variants of the classical stochastic gradient descent (SGD) but with additional features that promote faster convergence. In this paper, we compare the performance of the classical SGD with the novel techniques mentioned above. In addition, we propose an optimization procedure called RMSProp+AF, which is based on RMSProp algorithm but with the advantage of incorporating adaptation of the decaying factor. We show through simulations that all of these techniques---which are commonly used in the machine learning domain---can also be successfully applied to signal processing problems and are capable of attaining improved convergence and stability. Finally, it is also shown through simulations that the proposed method can outperform other competing approaches as both its convergence and stability are superior

Enhanced C-V2X mode-4 subchannel selection

In Release 14, the 3rd Generation Partnership Project (3GPP) introduced Cellular Vehicle--to--Everything (C-V2X) \textit{mode-4} as a novel disruptive technology to support sidelink vehicular communications in out--of--coverage scenarios. C-V2X \textit{mode-4} has been engineered to operate in a distributed manner, wherein vehicles autonomously monitor the received power across sidelink subchannels before selecting one for utilization. By means of such an strategy, vehicles attempt to $(i)$ discover and $(ii)$ reserve subchannels with low interference that may have the potential to maximize the reception likelihood of their own broadcasted safety messages. However, due to dynamicity of the vehicular environment, the subchannels optimality may fluctuate rapidly over time. As a consequence, vehicles are required to make a new selection every few hundreds of milliseconds. In consonance with 3GPP, the subchannel selection phase relies on the linear average of the perceived power intensities on each of the subchannels during a monitoring window. However, in this paper we propose a nonlinear power averaging phase, where the most up--to--date measurements are assigned higher priority via exponential weighting. We show through simulations that the overall system performance can be leveraged in both urban and freeway scenarios. Furthermore, the linear averaging can be considered as a special case of the exponentially-weighted moving average, ensuring backward compatibility with the standardized method. Finally, the 3GPP \textit{mode-4} scheduling approach is described in detail