Hypertension prevalence in Portugal: A systematic review and meta-analysis of population-based studies

Hypertension is a major risk factor for cardiovascular diseases and a critical public health issue globally. In Portugal, hypertension is common among older adults. Also, recent trends suggest that its prevalence may have changed over the last decade following the 2009 implementation of a public policy regulating the maximum amount of salt allowed in bread.

This systematic review and meta-analysis aimed to determine the prevalence of hypertension in Portugal across different age groups and genders, analyzing trends over the past two decades.

A systematic literature search was conducted using the PubMed and Cochrane databases, as well as additional sources including publications from the Statistics Portugal and the Portuguese National Health Institute. Population-based cross-sectional and cohort studies reporting the prevalence of hypertension among Portuguese adults, published between 2000 and 2020, were included. The overall prevalence of hypertension was estimated using a random effects meta-analysis model.

The overall prevalence of hypertension in Portugal was 31% (95% confidence interval (CI): 25.0%-37%, I²: 99.80%), with a prevalence of 34% in men (95% CI: 24%-46%, I²: 99.74%) and 33% in women (95% CI: 28%-38%, I²: 98.72%). Studies that measured blood pressure reported a higher prevalence (38%, 95% CI: 33%-43%, I²: 97.75%) compared to self-reported hypertension (24%, 95% CI: 21%-27%, I²: 99.20%). A downward trend in prevalence was observed in more recently published studies, especially in adults aged <35 years (from 17%, 95% CI: 12%-22%, I²: 0.81%-6%, 95% CI: 5%-8%, I²: 0.01%), and in individuals ≥65 years old from both sexes (from 80%, 95% CI: 77%-84%, I²: 61.09-73%, 95% CI: 70%-77%, I²: 63.69%).

Despite recent decreases, hypertension remains highly prevalent in Portugal, particularly among older adults. Self-reported data tend to underestimate the true prevalence of hypertension compared to blood pressure measurements.