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

Forouzanfar MH 1 , Liu P 1 , Roth GA 1 , Ng M 1 , Biryukov S 1 , Marczak L 1 Show all authors , Alexander L 1 , Estep K 1 , Hassen Abate K 2 , Akinyemiju TF 3 , Ali R 4 , Alvis-Guzman N 5 , Azzopardi P 6 , Banerjee A 7 , Bärnighausen T 8 , Basu A 9 , Bekele T 10 , Bennett DA 4 , Biadgilign S 11 , Catalá-López F 12 , Feigin VL 13 , Fernandes JC 14 , Fischer F 15 , Gebru AA 16 , Gona P 17 , Gupta R 18 , Hankey GJ 19 , Jonas JB 20 , Judd SE 21 , Khang YH 22 , Khosravi A 23 , Kim YJ 24 , Kimokoti RW 25 , Kokubo Y 26 , Kolte D 27 , Lopez A 28 , Lotufo PA 29 , Malekzadeh R 30 , Melaku YA 31 , Mensah GA 32 , Misganaw A 1 , Mokdad AH 1 , Moran AE 33 , Nawaz H 34 , Neal B 35 , Ngalesoni FN 36 , Ohkubo T 37 , Pourmalek F 38 , Rafay A 39 , Rai RK 40 , Rojas-Rueda D 41 , Sampson UK 42 , Santos IS 43 , Sawhney M 44 , Schutte AE 45 , Sepanlou SG 30 , Shifa GT 46 , Shiue I 47 , Tedla BA 48 , Thrift AG 49 , Tonelli M 50 , Truelsen T 51 , Tsilimparis N 52 , Ukwaja KN 53 , Uthman OA 54 , Vasankari T 55 , Venketasubramanian N 56 , Vlassov VV 57 , Vos T 1 , Westerman R 58 , Yan LL 59 , Yano Y 60 , Yonemoto N 61 , Zaki ME 62 , Murray CJ 1

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle
  • 2 Jimma University, Jimma, Ethiopia
  • 3 Department of Epidemiology, University of Alabama at Birmingham
  • 4 University of Oxford, Oxford, United Kingdom
  • 5 Universidad de Cartagena, Cartagena de Indias, Colombia
  • 6 Centre for Adolescent Health, Parkville, Victoria, Australia7South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  • 7 University College London, Farr Institute of Health Informatics Research, London, United Kingdom
  • 8 Harvard T.H. Chan School of Public Health, Boston, Massachusetts10Wellcome Trust Africa Centre for Health and Population Studies, Somkhele, Mtubatuba, KwaZulu-Natal, South Africa
  • 9 School of Health Sciences, University of Canterbury, Christchurch, New Zealand
  • 10 Madawalabu University, Bale Goba, Ethiopia
  • 11 Independent Public Health Consultants, Addis Ababa, Ethiopia
  • 12 University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Department of Medicine, Valencia, Spain15Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • 13 Auckland University of Technology, National Institute for Stroke and Applied Neurosciences, Auckland, New Zealand
  • 14 Pharmacology and Experimental Therapeutics, IBILI - Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • 15 Bielefeld University, Bielefeld, Germany
  • 16 Mekelle University, Mekelle, Ethiopia; Kilte Awlaelo-Health and Demographic Surveillance System
  • 17 University of Massachusetts Boston
  • 18 Eternal Heart Care Centre and Research Institute, Jaipur, India
  • 19 School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia23Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia24Western Australian Neuroscience Research Institute, Nedlands, Western Australia, Australia
  • 20 Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
  • 21 University of Alabama at Birmingham
  • 22 Seoul National University College of Medicine, Seoul, South Korea
  • 23 Iranian Ministry of Health and Medical Education, Tehran, Iran
  • 24 Southern University College, Johor, Malaysia
  • 25 Simmons College, Boston, Massachusetts
  • 26 National Cerebral and Cardiovascular Center, Department of Preventive Cardiology, Suita, Osaka, Japan
  • 27 Brown University/Rhode Island Hospital, Providence, Rhode Island
  • 28 University of Melbourne, Melbourne School of Population and Global Health, Melbourne, QLD, Australia
  • 29 University of São Paulo, São Paulo, Brazil
  • 30 Tehran Universities of Medical Sciences, Digestive Disease Research Institute, Tehran, Iran
  • 31 Mekelle University, School of Public Health, Mekelle, Ethiopia37The University of Adelaide, School of Medicine, Adelaide, South Australia, Australia
  • 32 National Institutes of Health, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 33 Columbia University, New York, New York
  • 34 Southern Illinois University, Springfield
  • 35 The George Institute for Global Health, Sydney, NSW, Australia42The University of Sydney, Sydney, New South Wales, Australia43Royal Prince Alfred Hospital, Sydney, New South Wales, Australia44Imperial College London, London, United Kingdom
  • 36 Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
  • 37 Teikyo University School of Medicine, Tokyo, Japan
  • 38 University of British Columbia, Vancouver, British Columbia, Canada
  • 39 Contech School of Public Health, Lahore, Punjab, Pakistan
  • 40 Society for Health and Demographic Surveillance, Suri, India
  • 41 ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  • 42 National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 43 University of São Paulo, Internal Medicine Department, São Paulo, Brazil
  • 44 Marshall University, Huntington, West Virginia
  • 45 Hypertension in Africa Research Team (HART); South African Medical Research Council, North-West University, Potchefstroom, South Africa
  • 46 Arba Minch University, Arba Minch, SNNPR, Ethiopia56Addis Ababa University, Addis Ababa, Ethiopia
  • 47 Northumbria University, Faculty of Health and Life Sciences, Newcastle upon Tyne, United Kingdom58University of Edinburgh, Alzheimer Scotland Dementia Research Centre, Edinburgh, United Kingdom
  • 48 University of Gondar, Gondar, Ethiopia; James Cook University, Cairns, Queensland, Australia
  • 49 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  • 50 University of Calgary, Calgary, Alberta, Canada
  • 51 University of Copenhagen, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
  • 52 University Heart Center of Hamburg, Hamburg, Germany
  • 53 Federal Teaching Hospital, Department of Internal Medicine, Abakaliki, Nigeria
  • 54 University of Warwick, Warwick Medical School, Coventry, United Kingdom
  • 55 UKK Institute for Health Promotion Research, Tampere, Finland
  • 56 Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  • 57 National Research University Higher School of Economics, Moscow, Russia
  • 58 Federal Institute for Population Research, Wiesbaden, Germany70German National Cohort Consortium, Heidelberg, Germany
  • 59 Global Health Research Center, Duke Kunshan University, Kunshan, China
  • 60 Department of Preventive Medicine, Northwestern University, Chicago, Illinois
  • 61 National Center of Neurology and Psychiatry, Kodaira, Japan
  • 62 Mansoura Faculty of Medicine, Mansoura, Egypt
JAMA, 2017 01 10;317(2):165-182.
PMID: 28097354 DOI: 10.1001/jama.2016.19043

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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