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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension
Zhou B, Perel P, Mensah GA, Ezzati M.. Nature reviews. Cardiology, 2021-05-28
Topic: Risk, prevention and care in population studies
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
Key findings
- In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries.
- Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population.
- The use and effectiveness of hypertension treatment vary substantially across countries.
- Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines.
- Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
Why it matters
This review notes that high blood pressure is a risk factor for dementia, among other diseases, and that lowering blood pressure through diet and treatment can help. It supports managing blood pressure as a way to reduce dementia risk, but does not test a specific Alzheimer's treatment.
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Study details
- Evidence strengthLow
How this study scored 60/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Nature reviews. Cardiology) |
| Journal's citation record | 3 / 4 | Nature Reviews Cardiology: journal h-index 250 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 1,528 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 218.3 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 6 / 6 | Cited 57.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 4 / 4 | Cited 998 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Majid Ezzati: h-index 148 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | National Institutes of Health: institution h-index 2,723 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 34050340) |
| Free to read | 2 / 2 | Free to read |
| Total | 60 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1038/s41569-021-00559-8
- PubMed: 34050340
- Original source →
- Free full text: Nature Reviews Cardiology →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Zhou, B., Perel, P., Mensah, G. A., & Ezzati, M. (2021). Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature reviews. Cardiology. https://doi.org/10.1038/s41569-021-00559-8
Vancouver
Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature reviews. Cardiology. 2021. doi:10.1038/s41569-021-00559-8. PMID: 34050340.
BibTeX
@article{zhou2021-34050340,
author = {Zhou, B. and Perel, P. and Mensah, G. A. and Ezzati, M.},
title = {{Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension}},
journal = {Nature reviews. Cardiology},
year = {2021},
doi = {10.1038/s41569-021-00559-8},
pmid = {34050340},
url = {https://doi.org/10.1038/s41569-021-00559-8}
}
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