Authors

Majid Ezzati, Imperial College London
Bin Zhou, Imperial College London
James Bentham, Imperial College London
Mariachiara Di Cesare, Middlesex University
Honor Bixby, Imperial College London
Goodarz Danaei, Harvard T.H. Chan School of Public Health
Kaveh Hajifathalian, Cleveland Clinic Foundation
Cristina Taddei, Imperial College London
Rodrigo M. Carrillo-Larco, Universidad Peruana Cayetano Heredia
Shirin Djalalinia, Tehran University of Medical Sciences
Shahab Khatibzadeh, Brandeis University
Charles Lugero, Mulago Hospital
Niloofar Peykari, Tehran University of Medical Sciences
Wan Zhu Zhang, Uganda Heart Institute
James Bennett, Imperial College London
Ver Bilano, Imperial College London
Gretchen A. Stevens, Organisation Mondiale de la Santé
Melanie J. Cowan, Organisation Mondiale de la Santé
Leanne M. Riley, Organisation Mondiale de la Santé
Zhengming Chen, University of Oxford
Ian R. Hambleton, The University of the West Indies
Rod T. Jackson, University of Auckland
Andre Pascal Kengne, South African Medical Research Council
Young Ho Khang, Seoul National University
Avula Laxmaiah, National Institute of Nutrition India
Jing Liu, Beijing Anzhen Hospital, Capital Medical University
Reza Malekzadeh, Tehran University of Medical Sciences
Hannelore K. Neuhauser, Robert Koch Institut
Maroje Sorić, University of Zagreb
Gregor Starc, University of Ljubljana
Johan Sundström, Uppsala Universitet
Tara Coppinger, Department of Sport, Leisure & Childhood Studies, Cork Institute of Technology, Cork, IrelandFollow
Janette Walton, Department of Biological Sciences, Cork Institute of Technology, Cork, IrelandFollow
Con Burns, Department of Sport, Leisure & Childhood Studies, Cork Institute of Technology, Cork, IrelandFollow
Mark Woodward, University of Oxford

ORCID

https://orcid.org/0000-0002-7251-4516

Document Type

Article

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Disciplines

Cardiovascular Diseases | Environmental Public Health | Medicine and Health | Public Health

Publication Details

© The Author(s) 2018.

NCD Risk Factor Collaboration (NCD-RisC), Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants, International Journal of Epidemiology, Volume 47, Issue 3, June 2018, Pages 872–883i, https://doi.org/10.1093/ije/dyy016

Abstract

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

Share

COinS