What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Hypertension (n=2648444). Primary outcome: Global pooled prevalence of uncontrolled hypertension (95% CI 52.1-57.1).

December 17, 2025BMC Public Health1 citationsOpen Access

The global prevalence of uncontrolled hypertension: a systematic review and meta-analysis

ZCZahra CheraghiHamedan University of Medical Sciences BABita Azmi-NaeiHamedan University of Medical Sciences PCParvin CheraghiHamedan University of Medical Sciences

Key Result

The global pooled prevalence of uncontrolled hypertension among hypertensive patients was 54.6%, indicating that more than half of treated patients worldwide do not achieve adequate blood pressure control.

Study Design

Type

Meta-Analysis (n=2,648,444)

Structured PICO

Population

2,648,444 adults with hypertension receiving anti-hypertensive treatment across 200 cross-sectional studies globally. Excluded: patients with chronic kidney diseases, pregnant women, HIV positive patients, multiple sclerosis, and history of stroke.

Outcome

Prevalence of uncontrolled hypertension (defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg despite receiving anti-hypertensive treatment)

More than half of treated hypertensive patients globally have uncontrolled blood pressure, emphasizing a critical gap in cardiovascular risk management and the urgent need for improved treatment strategies.

Limitations

High heterogeneity across the included studies limits the generalizability of the findings.
The full text of 44 articles was unavailable, leading to the exclusion of 30 studies and the inclusion of 14 based only on abstracts without methodological quality assessment.
Variations in the definition of uncontrolled hypertension across studies may have affected the accuracy of the pooled prevalence estimate.

Abstract

Despite available treatments, uncontrolled hypertension (systolic/diastolic blood pressure ≥ 140/90 mmHg despite medication) remains prevalent, contributing significantly to mortality. However, global estimates of its prevalence vary widely. We aimed to determine the pooled global prevalence of uncontrolled hypertension among hypertensive patients. We performed a systematic review and meta-analysis following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched using a predesigned search strategy up to August 2024. The cross-sectional studies which reported the prevalence of uncontrolled hypertension prevalence in adults were included. Two reviewers independently screened studies, extracted data, and assessed bias risk using the JBI checklist. The heterogeneity was evaluated using I² statistics. The inverse variance method was used in meta-analysis, and the random-effects model at a 95% confidence interval (CI) was used to the report of the results. Out of 3,500 identified references, 200 studies met the eligibility criteria and were included in this review. The global pooled prevalence of uncontrolled hypertension was 54.6% (95% CI: 52.1–57.1; I² = 99.97%). In the WHO African region, the Americas, South-East Asia, European region, Eastern Mediterranean, and the Western Pacific Region the pooled prevalence was 59.4% (95% CI: 54.4, 64.5; I²=97.11%); 49.7% (95% CI: 42.4, 56.9; I² = 99.98%); 44.2% (95% CI: 35.6, 52.7; I² = 99.86%); 53.7% (95% CI: 49.8, 57.7; I² = 99.89%); 60.0% (95% CI: 54.1, 65.8; I² = 99.47%); and 58.8% (95% CI: 51.5, 66.0; I² = 99.96%) respectively. Based on the results of this systematic review and meta-analysis, the global prevalence of uncontrolled hypertension was high. Based on the WHO regions, the highest and lowest prevalence was related to Eastern Mediterranean and South-East Asia respectively.

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