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  • Review Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis

Hypertension Research volume 45, pages 1225–1239 (2022)Cite this article

Abstract

This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I2 statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0–38.0%), with high between-study heterogeneity (I2 = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: −0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122–1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.

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Acknowledgements

We thank the authors of the included studies. We also thank John Daniel from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this paper.

Funding

This paper was funded by the Chengdu Science and Technology Bureau (Grant no. 2020-YF05-00290-SN).

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  1. Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China

    Xin Zhang, Zhipeng Zhang, Runyu Ye, Qingtao Meng & Xiaoping Chen

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  1. Xin Zhang
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Study design: XZ and XC. Data collection: XZ, ZZ, and RY. Analysis and interpretation of data: XZ and QM. Drafting of the paper: XZ. Approval of the final version for publication: all authors.

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Correspondence to Xiaoping Chen.

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Zhang, X., Zhang, Z., Ye, R. et al. Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis. Hypertens Res 45, 1225–1239 (2022). https://doi.org/10.1038/s41440-022-00955-8

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