Hypertension and Pre-Hypertension Among Iranian Adults Population: a Meta-Analysis of Prevalence, Awareness, Treatment, and Control

  • Roghaiyeh Afsargharehbagh
  • Khadije Rezaie-Keikhaie
  • Hosien Rafiemanesh
  • Abbas Balouchi
  • Salehoddin BouyaEmail author
  • Behroz Dehghan
Guidelines / Clinical Trials/Meta-Analysis (William J. Kostis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Guidelines/Clinical Trials/Meta-Analysis


Purpose of Review

This meta-analysis and systematic review was conducted to evaluate hypertension and prehypertension prevalence, awareness, treatment, and control in Iranian adults population.

Recent Findings

In this study, six international and national databases were searched from inception until August 30, 2018. Forty-eight studies performed on 417,392 participants were included in the meta-analysis. Based on the results of random effect method (95% CI), the overall prevalence of pre-hypertension, hypertension, awareness, treatment, and control were 31.6% (95% CI 24.9, 38.3; I2 = 99.7%), 20.4% (95% CI 16.5, 24.4; I2 = 99.9%), 49.3% (95% CI 44.8, 53.8; I2 = 98.5%), 44.8% (95% CI 28.3, 61.2; I2 = 99.9%), 37.4% (95% CI 29.0, 45.8; I2 = 99.3%), respectively.


Considering the increasing prevalence of pre-hypertension, hypertension, as well as more than half of the participants were unaware of their disease and were not treated, the results of the present study can help policy-makers to increase hypertension awareness, control, and treatment, especially in high-risk individuals.


Adults Prehypertension Prevalence Iran Hypertension Awareness 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Stevens G, Mascarenhas M, Mathers C. WHO brochure». Bulletin of the World Health Organization. 2009;87:646-.CrossRefGoogle Scholar
  2. 2.
    Federation WH. Cardiovascular disease risk factors. 2015. Accessed 27 september 2018.
  3. 3.
    •• Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.CrossRefGoogle Scholar
  4. 4.
    Negi PC, Chauhan R, Rana V, Lal K. Epidemiological study of non-communicable diseases (NCD) risk factors in tribal district of Kinnaur, HP: a cross-sectional study. Indian Heart J. 2016;68(5):655–62.CrossRefGoogle Scholar
  5. 5.
    •• Yusufali AM, Khatib R, Islam S, Alhabib KF, Bahonar A, Swidan HM, et al. Prevalence, awareness, treatment and control of hypertension in four Middle East countries. J Hypertens. 2017;35(7):1457–64. Scholar
  6. 6.
    •• Sarki AM, Nduka CU, Stranges S, Kandala N-B, Uthman OA. Prevalence of hypertension in low-and middle-income countries: a systematic review and meta-analysis. Medicine. 2015;94(50).CrossRefGoogle Scholar
  7. 7.
    •• Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27.CrossRefGoogle Scholar
  8. 8.
    •• Addo J, Smeeth L, Leon DA. Hypertension in sub-saharan Africa: a systematic review. Hypertension. 2007;50(6):1012–8.CrossRefGoogle Scholar
  9. 9.
    Sarraf Zadegan N, Boshtam M, Mostafavi S, Rafiei M. Prevalence of hypertension and associated risk factors in Isfahan, Islamic Republic of Iran. 1999.Google Scholar
  10. 10.
    Ebrahimi M, Heidari-Bakavoli AR, Mazidi M, Moohebati M, Azarpazhooh MR, Nematy M, et al. Prevalence of hypertension, pre-hypertension and undetected hypertension in Mashhad, Iran. Mediterr J Nutr Metab. 2016;9(3):213–23.CrossRefGoogle Scholar
  11. 11.
    •• Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens. 2013;31(7):1364–71.CrossRefGoogle Scholar
  12. 12.
    •• Adeloye D, Basquill C. Estimating the prevalence and awareness rates of hypertension in Africa: a systematic analysis. PLoS One. 2014;9(8):e104300.CrossRefGoogle Scholar
  13. 13.
    Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959–68.CrossRefGoogle Scholar
  14. 14.
    Mojahedi MJ, Hami M, Shakeri MT, Hasani MH, Ahadi M. The prevalence and related risk factors of hypertension in young adults in Mashhad hypertension in young adults. Med J Mashhad Univ Med Sci. 2015;58(5):252–7. Scholar
  15. 15.
    • Yazdanpanah L, Shahbazian H, Shahbazian H, Latifi S-M. Prevalence, awareness and risk factors of hypertension in southwest of Iran. J Renal Inj Prev. 2015;4(2):51.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefGoogle Scholar
  17. 17.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefGoogle Scholar
  18. 18.
    America N. Guidelines set new definitions, update treatment for hypertension. Bull World Health Organ. 1999;77(3).Google Scholar
  19. 19.
    • Gee ME, Campbell N, Sarrafzadegan N, Jafar T, Khalsa TK, Mangat B, et al. Standards for the uniform reporting of hypertension in adults using population survey data: recommendations from the World Hypertension League Expert Committee. J Clin Hypertens. 2014;16(11):773–81.CrossRefGoogle Scholar
  20. 20.
    McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6.CrossRefGoogle Scholar
  21. 21.
    • Isfeedvajani MS, Zarchi AAK, Heris AM, Sajjadi F, Tavana AM. Evaluation of personnel blood pressure and its risk factors in university affiliated medical centers: Irans Health Day 2013. Med J Islam Repub Iran. 2014;28(1).Google Scholar
  22. 22.
    Delavari A, Horri N, Alikhani S, Gouya M, Mahdavi A, Hosseini S, et al. Prevalence of hypertension in Iranian urban and rural populations aged over 20 years in 2004. JMUMS. 2007;17(58):79–86.Google Scholar
  23. 23.
    Sepanlou S, Sharafkhah M, Poustchi H, Malekzadeh M, Etemadi A, Khademi H, et al. Hypertension and mortality in the Golestan Cohort Study: a prospective study of 50 000 adults in Iran. J Hum Hypertens. 2016;30(4):260–7.CrossRefGoogle Scholar
  24. 24.
    Aghaei Meybodi HR, Khashayar P, Rezai Homami M, Heshmat R, Larijani B. Prevalence of hypertension in an Iranian population. Ren Fail. 2014;36(1):87–91. Scholar
  25. 25.
    Agheli N. Evaluation of risk factors of cardiovascular diseases in the Iranian population: role of hypertriglyceridemia. Angeiologie. 2006;58(3):24–7.Google Scholar
  26. 26.
    Amani S, Rahmani K, Ghaderi E, Bidarpour F, Rahimzadeh A, Rasaeian S. Prevalence of non-communicable diseases risk factors among the population of rural areas of Kurdistan Province, in Iran: a population-based study by rapid assessment method in 2015. Sci J Kurdistan Univ Med Sci. 2017;22(4):101–10.Google Scholar
  27. 27.
    Arefi SH, Hagh MHB, Naghavi M, Kassaian SE, Mar'Ashie SS, Mortazavi F, et al. Prevalence, patient awareness and control rates of high blood pressure in the adult population of Tehran: a report from the Tehran blood pressure study, 1990-1991. Med J Islam Repub Iran. 1996;10(2):125–35.Google Scholar
  28. 28.
    Assadi SN. Cardiovascular disorders risk factors in different industries of Iran. Int J Prev Med. 2013;4(6):728–33.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Azizi A, Abasi M, Abdoli G. The prevalence of hypertension and its association with age, sex and BMI in a population being educated using community-based medicine in Kermanshah: 2003. Iran J Endocrinol Metab. 2008;10(4):323–9.Google Scholar
  30. 30.
    Azizi F, Ghanbarian A. Distribution of blood pressure in Tehran's adult population: Tehran lipid and glucose study. Iran J Endocrinol Metab. 2003;5(4):425–35.Google Scholar
  31. 31.
    Baygi F, Jensen OC, Qorbani M, Farshad A, Salehi SA, Mohammadi-Nasrabadi F, et al. Prevalence and associated factors of cardio-metabolic risk factors in Iranian seafarers. Int Marit Health. 2016;67(2):59–65. Scholar
  32. 32.
    Chaman R, Younesian M, Hajimohammadi A, Gholamitaramsari M. Investigating hypertension prevalence and some of its influential factors in an ethnically variant rural sample. J Know Health Basic Med Sci. 2008;3(3):39–42. Scholar
  33. 33.
    Cheraghian B, Asadi-Lari M, Mansournia MA, Majdzadeh R, Mohammad K, Nedjat S, et al. Prevalence and associated factors of self-reported hypertension among Tehran adults in 2011: a population-based study (Urban HEART-2). Med J Islam Repub Iran. 2014;28:105.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Dabghmanesh M, Mostafavi H, Zare N. Blood pressure levels, risk factors and hypertension control status in adult. Hormozgan Med J. 2007;11(1):41–9.Google Scholar
  35. 35.
    Eghbali M, Khosravi A, Feizi A, Mansouri A, Mahaki B, Sarrafzadegan N. Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran. Epidemiol Health. 2018;40:e2018020. Scholar
  36. 36.
    Fakhrzadeh H, Bandarian F, Adibi H, Samavat T, Malekafzali H, Hodjatzadeh E, et al. Coronary heart disease and associated risk factors in Qazvin: a population-based study. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2008;14(1):33–41.Google Scholar
  37. 37.
    Fakhrzadeh H, Nouri M, Pour-Ebrahim R, Ghotbi S, Heshmat R, Bastanhagh M. Prevalence of hypertension and correlated risk factors among 25-64 aged inhabitants of Tehran university of medical sciences population lab region. IJDLD. 2004;3(0):37–43.Google Scholar
  38. 38.
    Gandomkar A, Poustchi H, Malekzadeh F, Malekzadeh MM, Moini M, Moghadami M, et al. Prevalence, awareness, treatment, control, and correlates of hypertension in the pars cohort study. Arch Iran Med. 2018;21(8):335–43.PubMedGoogle Scholar
  39. 39.
    Ghanbarian A, Rashidi A, Madjid M, Azizi F. Blood pressure measures and electrocardiogram-defined myocardial infarction in an Iranian population: Tehran Lipid and Glucose study. J Clin Hypertens (Greenwich, Conn). 2004;6(2):71–75.CrossRefGoogle Scholar
  40. 40.
    Ghorbani R, Askandarian R, Malek M, Rashidy-Pour A. Prevalence of hypertension among the adult population of Semnan province. Iran J Endocrinol Metab. 2009;10(5).Google Scholar
  41. 41.
    Ghorbani Z, Shamshirgaran SM, Ghaffari S, Sarbakhsh P, Najafipour F, Aminisani N. Hypertension prevalence, awareness, treatment and its correlates among people 35 years and older: result from pilot phase of the Azar cohort study. J Educ Health Promot. 2018;7:45. Scholar
  42. 42.
    Goodarzi M, Maseiainegad N. Outbreak of hypertension in the population over 18 years old in Zabol. Zahedan J Res Med Sci. 2002;4(4):9–15.Google Scholar
  43. 43.
    Hatmi Z, Tahvildari S, Motlag AG, Kashani AS. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord. 2007;7(1):32.CrossRefGoogle Scholar
  44. 44.
    Heydari ST, Khoshdel AR, Sabayan B, Abtahi F, Zamirian M, Sedaghat S. Prevalence of cardiovascular risk factors among military personnel in Southern Iran. Iran Cardiovasc Res J. 2010;4(1):22–7.Google Scholar
  45. 45.
    Jahromi MK, Hojat M, Koshkaki SR, Nazari F, Ragibnejad M. Risk factors of heart disease in nurses. Iran J Nurs Midwifery Res. 2017;22(4):332–7. Scholar
  46. 46.
    Kazemi T, Hajihosseini M, Mashreghimoghadam H, Azdaki N, Ziaee M. Prevalence and determinants of hypertension among Iranian adults, Birjand, Iran. Int J Prev Med. 2017;8:36. Scholar
  47. 47.
    Kelishadi R, Gharipour M, Sadri GH, Tavasoli AA, Amani A. Cardiovascular disease risk factors, metabolic syndrome and obesity in an Iranian population. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2008;14(5):1070–9.Google Scholar
  48. 48.
    Khajedaluee M, Hassannia T, Rezaee A, Ziadi M, Dadgarmoghaddam M. The prevalence of hypertension and its relationship with demographic factors, biochemical, and anthropometric indicators: a population-based study. ARYA atherosclerosis. 2016;12(6):259–65.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Khani M, Vakili M, Ansari A, Mosavinasab N. Prevalence of hypertension and some related risk factors in rural population affiliated to Tarom health network in 2001. J Zanjan Univ Med Sci. 2002;10(40):23–9.Google Scholar
  50. 50.
    Khoshandam Sarvynehbaghi F, Reza Mozaffari SA, Yaghoubi Poor A, Nezamtabar MA. Prevalence of hypertension among professional drivers in Mazandaran province, 2010. JMUMS. 2013;23(102):24–9.Google Scholar
  51. 51.
    Khosravi A, Emamian MH, Shariati M, Hashemi H, Fotouhi A. The prevalence of pre-hypertension and hypertension in an Iranian urban population. High Blood Press Cardiovasc Prev. 2014;21(2):127–35. Scholar
  52. 52.
    Najafipour H, Mirzazadeh A, Haghdoost AA, Shadkam M, Afshari M, Moazenzadeh M, et al. Coronary artery disease risk factors in an urban and pen-urban setting, Kerman, southeastern Iran (KERCADR study): methodology and preliminary report. Iran J Public Health. 2012;41(9):86–92.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Namayandeh S, Sadr S, Rafiei M, Modares-Mosadegh M, Rajaefard M. Hypertension in Iranian urban population, epidemiology, awareness, treatment and control. Iran J Public Health. 2011;40(3):63–70.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Pakzad B, Akbari M, Baberi F. Prevalence, awareness, treatment, and control of hypertension in an Isfahan state institution sample. J Tehran Uni Heart Cent. 2018;13(2):65–72.Google Scholar
  55. 55.
    Peymani P, Heydari ST, Ahmadi SM, Sarikhani Y, Joulaei H, Moghadami M, et al. The prevalence of high blood pressure and its relationship with anthropometric indicators; a population based study in Fars Province. IR Iran Iran Cardiovasc Res J. 2012;6(2):40–5.Google Scholar
  56. 56.
    Ramezani MA, Dastanpour M, Eshaghi SR, Fadaee-Nobari R, Heydari K. Determinants of awareness, treatment and control of hypertension in Isfahan. Central Iran Arch Med Sci. 2009;5(4):523–30.Google Scholar
  57. 57.
    Ramezankhani A, Kabir A, Pournik O, Azizi F, Hadaegh F. Classification-based data mining for identification of risk patterns associated with hypertension in Middle Eastern population: A 12-year longitudinal study. Medicine. 2016;95(35). Scholar
  58. 58.
    Sadeghi M, Roohafza HR, Kelishadi R. Blood pressure and associated cardiovascular risk factors in Iran: Isfahan Healthy Heart Programme. Med J Malaysia. 2004;59(4):460–7.PubMedGoogle Scholar
  59. 59.
    Sahebi L, Vahidi RG, Mousavi SH. Prevalence of hypertension and associated variables in hospital staff in Iran. Acta Med Saliniana. 2010;39(1):6–13. Scholar
  60. 60.
    Sahraki MR, Mirshekari H, Sahraki AR, Mohammadi M, Sahraki E, Khazaei FA. Hypertension among 30+ year-old people in Zahedan (Southeast of Iran). Shiraz E Med J. 2011;12(3):129–34.Google Scholar
  61. 61.
    Shirani S, Gharipour M, Khosravi A. Gender differences in the prevalence of hypertension in a representative sample of Iranian population: the Isfahan Healthy Heart Program. Acta Bio Medica Atenei Parmensis. 2011;82(3):223–9.PubMedGoogle Scholar
  62. 62.
    Tabrizi JS, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz L, Nikniaz Z. Prevalence and associated factors of prehypertension and hypertension in Iranian population: the lifestyle promotion project (LPP). PLoS One. 2016;11(10):e0165264. Scholar
  63. 63.
    • Mirzaei M, Moayedallaie S, Jabbari L, Mohammadi M. Prevalence of hypertension in Iran 1980–2012: a systematic review. J Tehran Univ Heart Cent. 2016;11(4):159.Google Scholar
  64. 64.
    • Rezazadehkermani M. Epidemiology and heterogeneity of hypertension in Iran: a systematic review. Arch Iran Med. 2008;11(4):444–52.PubMedGoogle Scholar
  65. 65.
    Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control clinical perspective: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50.CrossRefGoogle Scholar
  66. 66.
    Picon RV, Fuchs FD, Moreira LB, Riegel G, Fuchs SC. Trends in prevalence of hypertension in Brazil: a systematic review with meta-analysis. PLoS One. 2012;7(10):e48255.CrossRefGoogle Scholar
  67. 67.
    Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32(6):1170–7.CrossRefGoogle Scholar
  68. 68.
    Fateh M, Emamian MH, Asgari F, Alami A, Fotouhi A. Socioeconomic inequality in hypertension in Iran. J Hypertens. 2014;32(9):1782–8.CrossRefGoogle Scholar
  69. 69.
    Post Hospers G, Smulders Y, Maier AB, Deeg D, Muller M. Relation between blood pressure and mortality risk in an older population: role of chronological and biological age. J Intern Med. 2015;277(4):488–97.CrossRefGoogle Scholar
  70. 70.
    Guo X, Zou L, Zhang X, Li J, Zheng L, Sun Z, et al. Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Tex Heart Inst J. 2011;38(6):643.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S. Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey. PLoS One. 2017;12(12):e0188619.CrossRefGoogle Scholar
  72. 72.
    Hu L, Huang X, You C, Li J, Hong K, Li P, et al. Prevalence and risk factors of prehypertension and hypertension in Southern China. PLoS One. 2017;12(1):e0170238.CrossRefGoogle Scholar
  73. 73.
    Choi KM, Park HS, Han JH, Lee JS, Lee J, Ryu OH, et al. Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001. J Hypertens. 2006;24(8):1515–21.CrossRefGoogle Scholar
  74. 74.
    Erem C, Hacihasanoglu A, Kocak M, Deger O, Topbas M. Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon hypertension study. J Public Health. 2008;31(1):47–58.CrossRefGoogle Scholar
  75. 75.
    Harries AD, Kumar AM, Karpati A, Jahn A, Douglas GP, Gadabu OJ, et al. Monitoring treatment outcomes in patients with chronic disease: lessons from tuberculosis and HIV/AIDS care and treatment programmes. Tropical Med Int Health. 2015;20(7):961–4.CrossRefGoogle Scholar
  76. 76.
    Dzudie A, Kengne AP, Muna WF, Ba H, Menanga A, Kouam CK, et al. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ Open. 2012;2(4):e001217.CrossRefGoogle Scholar
  77. 77.
    Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, et al. Prevalence, awareness, treatment, and control of hypertension in China. Hypertension. 2002;40(6):920–7.CrossRefGoogle Scholar
  78. 78.
    Hien HA, Tam NM, Tam V, Derese A, Devroey D. Prevalence, awareness, treatment, and control of hypertension and its risk factors in (central) Vietnam. Int J Hypertens. 2018;2018:1–12.CrossRefGoogle Scholar
  79. 79.
    Feng XL, Pang M, Beard J. Health system strengthening and hypertension awareness, treatment and control: data from the China health and retirement longitudinal study. Bull World Health Organ. 2013;92:29–41.CrossRefGoogle Scholar
  80. 80.
    Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008;23(4):335–9.CrossRefGoogle Scholar

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Authors and Affiliations

  • Roghaiyeh Afsargharehbagh
    • 1
  • Khadije Rezaie-Keikhaie
    • 2
  • Hosien Rafiemanesh
    • 3
  • Abbas Balouchi
    • 4
  • Salehoddin Bouya
    • 5
    • 6
    Email author
  • Behroz Dehghan
    • 6
  1. 1.Department of Cardiology, Shohada HospitalUrmia University of Medical ScienceUrmiaIran
  2. 2.Zabol Medicinal Plants Research CenterZabol University of Medical SciencesZabolIran
  3. 3.Student Research Committee, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Student Research Committee, Nursing and Midwifery SchoolIran University of Medical SciencesTehranIran
  5. 5.Internal Medicine and Nephrology, Clinical Immunology Research CenterAli-Ebne Abitaleb Hospital, Zahedan University of Medical SciencesZahedanIran
  6. 6.Zahedan University of Medical SciencesZahedanIran

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