Prevalence and trends of hypertension among South Asian adults: a systematic review and meta-analysis

Hypertension, a major contributor to global cardiovascular disease related deaths, has seen a rise in low- and middle-income countries, especially in South Asia (SA) where ongoing demographic and lifestyle transitions are constantly elevating the cardiometabolic risk. We aimed to generate policy-relevant region-specific estimates of hypertension prevalence and temporal trends in SA in the past 25 years. A comprehensive systematic search of online databases (PubMed, Web of Science, Scopus), WHO STEPS surveys, and demographic and health surveys were conducted. Of 11 773 journal articles and 50 reports identified, 33 articles and 25 reports met inclusion criteria after screening by two independent reviewers. The pooled prevalence of hypertension in SA has increased from 24.6% (95%CI 18.5–30.6) in 2000–04 to 26.0% (95%CI 20.3–31.7) in 2020–25. According to the latest data, Pakistan reports the highest (46.2%, 95%CI 45.2–47.2), while Bangladesh reports the lowest (20.4%, 95%CI 19.8–21.1) prevalence of the region. Hypertension prevalence has risen in most countries in SA in the past two decades, with Sri Lanka witnessing the steepest rise. Although hypertension has historically been more prevalent in urban populations, rural prevalence has seen a sharp rise over the years, likely linked to rapid urbanization. Nearly 1.3 billion adults in SA (37.5%; 95%CI 30.4–44.5) are pre-hypertensive. The region demonstrated a high Hypertension Epidemicity Index of 60.1%, indicating a substantial epidemic potential in the future, highlighting the need for urgent translation of existing policies into effective implementation to mitigate growing cardiovascular burden.