Biomedical Sciences

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Review Article |

Hypertension: Unmasking the Silent Epidemic in Developing Countries

Background: An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, about two-thirds of them live in low- and middle-income countries. A systolic blood pressure (BP) > 180 mm Hg or a diastolic BP > 120 mm Hg is considered a "hypertensive crisis." Almost three-quarters of the worldwide deaths due to hypertension are reported in developing countries where hypertension awareness is deficient, and prevalence rates are very high. The aging population, unhealthy diets, and lack of physical activities are some of the factors that are contributing to high levels of hypertension. Resistant hypertension, where a patient fails to respond to three or more different classes of antihypertensive drugs, including a diuretic, is also on the rise. The Purpose: This review briefly summarizes the current trends of hypertension in developing countries, its causes, diagnosis, and treatment. It also covers the recent increase in the use of antihypertensive herbs. Research Methods: The review critically analyzed recent hypertension trends in developing countries, with a special focus on resistant hypertension diagnosis and treatment. Conclusion: Training people to diagnose hypertension in hard-to-reach areas is highly recommended to reduce hypertension cases in developing countries. People should be encouraged to eat healthy diets and actively participate in physical exercises. More research is needed in the development and treatment of resistant hypertension.

Resistant Hypertension, Hypertension Treatment, Diagnosis of Hypertension, Hypertension Genetics, Hypertension Herbs

APA Style

Symon Katete, R. (2023). Hypertension: Unmasking the Silent Epidemic in Developing Countries. Biomedical Sciences, 9(4), 84-96. https://doi.org/10.11648/j.bs.20230904.12

ACS Style

Symon Katete, R. Hypertension: Unmasking the Silent Epidemic in Developing Countries. Biomed. Sci. 2023, 9(4), 84-96. doi: 10.11648/j.bs.20230904.12

AMA Style

Symon Katete R. Hypertension: Unmasking the Silent Epidemic in Developing Countries. Biomed Sci. 2023;9(4):84-96. doi: 10.11648/j.bs.20230904.12

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. World Health Organization (WHO). Hypertension fact sheet. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 17th October 2023.
2. Naranjo M, Chauhan S, Paul M. Malignant Hypertension. In StatPearls. StatPearls Publishing, 2023.
3. Mills KT, Stefanescu A, He J. (2020). The global epidemiology of hypertension. Nature reviews. Nephrology, 2020; 16 (4): 223–237.
4. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19• 1 million participants. The Lancet, 2017; 389 (10064): 37-55.
5. Ogunniyi MO, Commodore-Mensah Y, Ferdinand KC. Race, Ethnicity, Hypertension, and heart disease: JACC Focus Seminar 1/9. J Am Coll Cardiol., 2021; 78 (24): 2460-2470.
6. Doroszko A, Janus A, Szahidewicz-Krupska E, Mazur G, Derkacz A. Resistant Hypertension. Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University, 2016; 25 (1): 173–183.
7. World Health Organization (WHO). First WHO report details devastating impact of hypertension and ways to stop it. https://www.who.int/news/item/19-09-2023-first-who-report-details-devastating-impact-of-hypertension-and-ways-to-stop-itAccessed 17 October 2023.
8. Oparil S, Acelajado MC, Bakris G, Berlowitz, DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nature Reviews Disease Primers, 2018; 4: 18014.
9. Odden MC, Beilby PR, Peralta CA. Blood Pressure in Older Adults: The Importance of Frailty. Curr Hypertens Rep. 2015; 17 (7): 55.
10. Metoki H, Kuriyama S. Combination of genetic and environmental factors for childhood hypertension: a simple indicator of family history remains useful. Hypertens Res. 2023; 46 (4): 1061-1063.
11. Jang S, Kim ST, Kim YK, Song YH. Association of blood pressure and hypertension between parents and offspring: The Korea National Health and Nutrition Examination Survey. Hypertension Research: official journal of the Japanese Society of Hypertension, 2023; 46 (2): 368–376.
12. Wang Z, Lu C, Wang Y, et al. Association between ultra-processed foods consumption and the risk of hypertension: An umbrella review of systematic reviews. Hellenic J Cardiol., 2023; S1109-9666(23)00137-9.
13. Zhou L, Feng W, Xiang N, et al. Association between physical activity dimensions and the risk of hypertension among middle and older adults: A cross-sectional study in China. Front Public Health, 2022; 10: 995755.
14. Ohldieck AE, Kringeland E, Midtbø H, Tell GS, Gerdts E. High-normal blood pressure in midlife is a stronger risk factor for incident hypertension 26 years later in women than men: the Hordaland Health Study. Blood Press. 2023; 32 (1): 2179337.
15. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol., 2015; 61 (1): 1-17.
16. Park S. Ideal Target Blood Pressure in Hypertension. Korean Circ J., 2019; 49 (11): 1002-1009.
17. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol., 2021; 18 (11): 785-802.
18. Marczak L, Williams J, Loeffler M, for the For the Institute for Health Metrics and Evaluation. Global Deaths Attributable to High Systolic Blood Pressure, 1990-2016. JAMA, 2018; 319 (21): 2163.
19. Fuchs FD, Whelton PK. High blood pressure and cardiovascular disease. Hypertension, 2020; 75 (2): 285-292.
20. Poznyak AV, Sadykhov NK, Kartuesov AG, et al. Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment. Front Cardiovasc Med., 2022; 9: 959285.
21. Canoy D, Nazarzadeh M, Copland E, Bidel Z, Rao S, Li Y, Rahimi K. How Much Lowering of Blood Pressure Is Required to Prevent Cardiovascular Disease in Patients with and Without Previous Cardiovascular Disease? Current Cardiology Reports, 2024; 24 (7): 851–860.
22. Kamalumpundi V, Shams E, Tucker C, Cheng L, Peterson J, Thangavel S, Ofori O, Correia M. Mechanisms and pharmacotherapy of hypertension associated with type 2 diabetes. Biochemical Pharmacology, 2022; 206: 115304.
23. McFarlane SI, Jean-Louis G, Zizi F, et al. Hypertension in the high-cardiovascular-risk populations. Int J Hypertens., 2011; 2011: 746369.
24. Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED, Güngör T, Çelikkaya E, Karakaya D, Bülbül M. Clinical assessment of primary and secondary hypertension in children and adolescents. Archives De Pediatrie: Organe Officiel De La Societe Francaise De Pediatrie, 2020; 27 (6): 286–291.
25. Charles L, Triscott J, Dobbs B. (2017). Secondary Hypertension: Discovering the Underlying Cause. American Family Physician, 2017; 96 (7): 453–461.
26. Harrison DG, Coffman TM, Wilcox CS. Pathophysiology of Hypertension: The Mosaic Theory and Beyond. Circulation Research, 2021; 128 (7): 847–863.
27. Raina R, Krishnappa V, Das A, et al. Overview of Monogenic or Mendelian Forms of Hypertension. Front Pediatr. 2019; 7: 263.
28. Padmanabhan S, Dominiczak AF. Genomics of hypertension: the road to precision medicine. Nat Rev Cardiol., 2021; 18 (4): 235-250.
29. Garimella PS, du Toit C, Le NN, Padmanabhan S. A genomic deep field view of hypertension. Kidney International, 2023; 103 (1): 42–52.
30. Schutte AE, Srinivasapura Venkateshmurthy N, Mohan S, Prabhakaran D. Hypertension in Low- and Middle-Income Countries. Circ Res., 2021; 128 (7): 808-826.
31. Cavagna P, Leplay C, N'Guetta R, Kramoh KE, Diop IB, Balde DM, Mipinda JB, Azizi M, Jouven X, Antignac M. Hypertension treatment in sub-Saharan Africa: a systematic review. Cardiovascular Journal of Africa, 2023; 34: 1–11.
32. Marinier K, Macouillard P, de Champvallins M, Deltour N, Poulter N, Mancia G. Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink. Pharmacoepidemiol Drug Saf., 2019; 28 (12): 1572-1582.
33. Kehrenberg MCA, Bachmann HS. Diuretics: a contemporary pharmacological classification? Naunyn-Schmiedeberg's Archives Of Pharmacology, 2022; 395 (6): 619–627.
34. Reinhart M, Puil L, Salzwedel DM, Wright JM. First-line diuretics versus other classes of antihypertensive drugs for hypertension. Cochrane Database Syst Rev., 2023; 7 (7): CD008161.
35. Frishman WH, Saunders E. β-Adrenergic blockers. Journal of Clinical Hypertension (Greenwich, Conn.), 2011; 13 (9): 649–653.
36. Antza C, Stabouli S, Kotsis V. Combination therapy with lercanidipine and enalapril in the management of the hypertensive patient: an update of the evidence. Vascular Health and Risk Management, 2016; 12: 443–451.
37. Fici F, Robles NR, Tengiz I, Grassi G. Beta-Blockers, and Hypertension: Some Questions and Answers. High Blood Pressure & Cardiovascular Prevention: the official journal of the Italian Society of Hypertension, 2023; 30 (3); 191–198.
38. Ahmad H, Khan H, Haque S, Ahmad S, Srivastava N, Khan A. Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension. Journal of The Renin-Angiotensin-Aldosterone System: JRAAS, 2023; 7890188.
39. Park CS, Kim B, Rhee TM, et al. Association between renin-angiotensin-aldosterone system blockade and clinical outcomes in patients with hypertension: real-world observation from a nationwide hypertension cohort. Clin Res Cardiol, 2023.
40. Maron BA, Leopold JA. Aldosterone receptor antagonists: effective but often forgotten. Circulation. 2010; 121 (7): 934-939.
41. Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens (Greenwich). 2011; 13 (9): 639-643.
42. Martins, V. M., Ziegelmann, P. K., Ferrari, F., Bottino, L. G., Lucca, M. B., Corrêa, H. L. R., Blum, G. B., Helal, L., Fuchs, S. C., & Fuchs, F. D. (2023). Thiazide diuretics alone or combined with potassium-sparing diuretics to treat hypertension: a systematic review and network meta-analysis of randomized controlled trials. Journal of hypertension, 41 (7), 1108–1116.
43. Li JF, Chen YQ, Wang L, Cao YS, Yuan JX. Editorial: Calcium and pulmonary hypertension. Frontiers in Physiology, 2022; 13: 1019158.
44. Pathak A, Mrabeti S. β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now? Vasc Health Risk Manag., 2021; 17: 337-348.
45. Sharifan A, Bahreini M, Ashraf H, Najmeddin F. Blood Pressure Control Following Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: Insights from a Triple-Blind, Randomized, Clinical Trial. J Clin Pharmacol., 2023; 10.1002/jcph.2294.
46. Rao GA, Mann JR, Shoaibi A, et al. Angiotensin receptor blockers: are they related to lung cancer? J Hypertens. 2013; 31 (8): 1669-1675.
47. Skolnik NS, Beck JD, Clark M. Combination antihypertensive drugs: recommendations for use. Am Fam Physician, 2000; 61 (10): 3049-3056.
48. Shalaeva EV, Messerli FH. (2023). What is resistant arterial hypertension? Blood Pressure, 2023; 32 (1): 2185457.
49. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement from the American Heart Association. Hypertension (Dallas, Tex.: 1979), 2018; 72 (5): e53–e90.
50. Galletti F, Barbato A. Prevalence and determinants of resistant hypertension in a sample of patients followed in Italian hypertension centers: results from the MINISAL-SIIA study program. Journal of human hypertension, 2016; 30 (11): 703-708.
51. Rimoldi SF, Messerli FH, Bangalore S, Scherrer U. Resistant hypertension: what the cardiologist needs to know. Eur Heart J. 2015; 36 (40): 2686-2695.
52. Tabassum N, Ahmad F. Role of natural herbs in the treatment of hypertension. Pharmacogn Rev., 2011; 5 (9): 30-40.
53. Kamyab R, Namdar H, Torbati M, Ghojazadeh M, Araj-Khodaei M, Fazljou SMB. Medicinal Plants in the Treatment of Hypertension: A Review. Advanced Pharmaceutical Bulletin, 2021; 11 (4): 601–617.
54. Verma T, Sinha M, Bansal N, Yadav SR, Shah K, Chauhan NS. Plants Used as Antihypertensive. Nat Prod Bioprospect., 2021; 11 (2): 155-184.
55. Al Disi SS, Anwar MA, Eid AH. Anti-hypertensive Herbs and their Mechanisms of Action: Part I. Front. Pharmacol., 2016; 6: 323.
56. Anwar MA, Al Disi SS, Eid AH. Anti-Hypertensive Herbs and Their Mechanisms of Action: Part II. Front. Pharmacol., 2016; 7: 50.
57. Shayani Rad M, Moohebati M, Mohajeri SA. Effect of celery (Apium graveolens) seed extract on hypertension: A randomized, triple-blind, placebo-controlled, cross-over, clinical trial. Phytother Res., 2022; 36 (7): 2889-2907.
58. Song D, Hao J, Fan D. Biological properties and clinical applications of berberine. Front Med., 2020; 14 (5): 564-582.
59. Wang X, Liu Y, Wang Y, et al. Protective Effect of Coriander (Coriandrum sativum L.) on High-Fructose and High-Salt Diet-Induced Hypertension: Relevant to Improvement of Renal and Intestinal Function. J Agric Food Chem., 2022; 70 (12): 3730-3744.
60. Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens., 2015; 33 (6): 1119-1127.
61. Tcheutchoua YC, Bilanda DC, Dzeufiet PDD, et al. Preventive Potential of the Aqueous Extract of the Mixture of Bidens pilosa (Asteraceae) and Cymbopogon citratus (Poaceae) Aerial Parts on Hypertension Induced by a Chronic Salt and Alcohol Consumption on the Rats. Evid Based Complement Alternat Med., 2022; 2022: 1980622.
62. Chiang SS, Chen LS, Chu CY. Active food ingredients production from cold pressed processing residues of Camellia oleifera and Camellia sinensis seeds for regulation of blood pressure and vascular function. Chemosphere, 2021; 267: 129267.
63. Maideen NMP, Balasubramanian R, Ramanathan S. Nigella Sativa (Black Seeds), A Potential Herb for the Pharmacotherapeutic Management of Hypertension - A Review. Current Cardiology Reviews, 2021; 17 (4): e230421187786.
64. Wu R, Zhou Y, Xu H, et al. Aqueous extract of Salvia miltiorrhiza Bunge reduces blood pressure through inhibiting oxidative stress, inflammation and fibrosis of adventitia in primary hypertension. Front Pharmacol., 2023; 14: 1093669.
65. Abbas K, Rizwani GH, Qadir MI, Younis M, Qaisar MN, Siddique FA, Aamir MN, Wazir A, Shaheer T. (2023). Herbal Formulation Comprised of Methanol Extracts of Tribulus terristris L. and Zingiber officinale Roscoe Has Antihypertensive Effects. Alternative Therapies in Health and Medicine, 2023; 29 (4): 234–239.
66. Serrano JCE, Castro-Boqué E, García-Carrasco A, et al. Antihypertensive Effects of an Optimized Aged Garlic Extract in Subjects with Grade I Hypertension and Antihypertensive Drug Therapy: A Randomized, Triple-Blind Controlled Trial. Nutrients, 2023; 15 (17): 3691.