Mean systolic blood pressure above the control threshold in people with treated uncontrolled hypertension: a pooled, cross-sectional analysis of 55 national health surveys

BACKGROUND: The hypertension care cascade has been characterized worldwide, yet it has not been quantified how far above the blood pressure control threshold people with uncontrolled treated hypertension are. We summarized the mean systolic blood pressure (SBP; mmHg) in people treated for hypertension but SBP not <130/80. METHODS: We did a cross-sectional analysis of 55 WHO STEPS Surveys (n = 10,658), comprising six world regions (Africa, Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific); we only included the most recent survey by country regardless of when it was conducted. Adults, men and women, aged between 25 and 69 years, with self-reported hypertension receiving antihypertensive medication and whose blood pressure was >130/80 mmHg were included. We quantified the mean SBP overall and by socio-demographic (sex, age, urban/rural location, education) and cardiometabolic (current smoking, self-reported diabetes) risk factors. FINDINGS: The lowest SBP was observed in Kuwait (146.6; 95% CI: 143.8–149.4 mmHg) and the highest in Libya (171.9; 95% CI: 167.8–176.0 mmHg). In 29 countries, the SBP was higher in men, and SBP tended to be higher in older groups except in six countries. In 17 countries, the SBP was higher in rural than in urban sites, for example in Turkmenistan the SBP was 162.3 (95% CI: 158.4–166.2) mmHg in rural versus 151.6 (95% CI: 148.7–154.4) mmHg in urban areas. In 25 countries, the SBP was higher in adults with no education, for example in Benin the SBP in people without formal education was 175.3 (95% CI: 168.8–181.9) mmHg versus 156.4 (95% CI: 148.8–164.0) mmHg in people with higher education. INTERPRETATION: Stronger interventions to improve and secure access to effective management are needed in most countries and specific groups, to reach hypertension control in people with hypertension already receiving antihypertensive medication. FUNDING: The 10.13039/100010269Wellcome Trust International Training Fellowship (214185/Z/18/Z).