Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Mohammad H Forouzanfar, Patrick Liu, Gregory A Roth, Marie Ng, Stan Biryukov, Laurie Marczak, Lily Alexander, Kara Estep, Kalkidan Hassen Abate, Tomi F Akinyemiju, Raghib Ali, Nelson Alvis-Guzman, Peter Azzopardi, Amitava Banerjee, Till Bärnighausen, Arindam Basu, Tolesa Bekele, Derrick A Bennett, Sibhatu Biadgilign, Ferrán Catalá-LópezValery L Feigin, Joao C Fernandes, Florian Fischer, Alemseged Aregay Gebru, Philimon Gona, Rajeev Gupta, Graeme J Hankey, Jost B Jonas, Suzanne E Judd, Young-Ho Khang, Ardeshir Khosravi, Yun Jin Kim, Ruth W Kimokoti, Yoshihiro Kokubo, Dhaval Kolte, Alan Lopez, Paulo A Lotufo, Reza Malekzadeh, Yohannes Adama Melaku, George A Mensah, Awoke Misganaw, Ali H Mokdad, Andrew E Moran, Haseeb Nawaz, Bruce Neal, Frida Namnyak Ngalesoni, Takayoshi Ohkubo, Farshad Pourmalek, Anwar Rafay, Rajesh Kumar Rai, David Rojas-Rueda, Uchechukwu K Sampson, Itamar S Santos, Monika Sawhney, Aletta E Schutte, Sadaf G Sepanlou, Girma Temam Shifa, Ivy Shiue, Bemnet Amare Tedla, Amanda G Thrift, Marcello Tonelli, Thomas Truelsen, Nikolaos Tsilimparis, Kingsley Nnanna Ukwaja, Olalekan A Uthman, Tommi Vasankari, Narayanaswamy Venketasubramanian, Vasiliy Victorovich Vlassov, Theo Vos, Ronny Westerman, Lijing L Yan, Yuichiro Yano, Naohiro Yonemoto, Maysaa El Sayed Zaki, Christopher J L Murray

1515 Citations (Scopus)

Abstract

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions.

Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015.

Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis.

Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year.

Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). For loss of DALYs associated with systolic blood pressure of 140 mm Hg or higher, the loss increased from 95.9 million (95% uncertainty interval [UI], 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million) [corrected], and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg.

Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.

Original languageEnglish
JournalJAMA - Journal of the American Medical Association
Volume317
Issue number2
Pages (from-to)165-182
ISSN0002-9955
DOIs
Publication statusPublished - 2017

Keywords

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Cause of Death
  • Female
  • Global Health
  • Health Surveys
  • Humans
  • Hypertension
  • Intracranial Hemorrhages
  • Male
  • Middle Aged
  • Monte Carlo Method
  • Myocardial Ischemia
  • Normal Distribution
  • Prevalence
  • Quality-Adjusted Life Years
  • Renal Insufficiency, Chronic
  • Risk Assessment
  • Sex Distribution
  • Stroke
  • Systole
  • Uncertainty
  • Journal Article
  • Research Support, Non-U.S. Gov't

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