Authors

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
Melanie J. Cowan, Organisation Mondiale de la Santé
Christopher J. Paciorek, University of California, Berkeley
Gitanjali Singh, Tufts University
Kaveh Hajifathalian, Harvard T.H. Chan School of Public Health
James E. Bennett, Imperial College London
Cristina Taddei, Imperial College London
Con Burns, Department of Sport, Leisure & Childhood Studies, Cork Institute of Technology, Cork, IrelandFollow
Tara Coppinger, Department of Sport, Leisure & Childhood Studies, Cork Institute of Technology, Cork, IrelandFollow
Ver Bilano, 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, Mulago Hospital
Yuan Lu, Yale University
Gretchen A. Stevens, Organisation Mondiale de la Santé
Leanne M. Riley, Organisation Mondiale de la Santé
Pascal Bovet, Université de Lausanne (UNIL)
Paul Elliott, Imperial College London
Dongfeng Gu, National Center for Cardiovascular Diseases
Nayu Ikeda, National Institute of Health and Nutrition Tokyo
Rod T. Jackson, University of Auckland
Michel Joffres, Simon Fraser University
Andre Pascal Kengne, South African Medical Research Council
Tiina Laatikainen, National Institute for Health and Welfare
Tai Hing Lam, The University of Hong Kong
Avula Laxmaiah, National Institute of Nutrition India
Jing Liu, Beijing Anzhen Hospital, Capital Medical University

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

© 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Abstract

Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. Funding Wellcome Trust.

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