Worldwide trends in blood pressure from 1975 to 2015

a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

Bin Zhou, James Bentham, Mariachiara Di Cesare, Honor Bixby, Goodarz Danaei, Melanie J. Cowan, Christopher J. Paciorek, Gitanjali Singh, Kaveh Hajifathalian, James E. Bennett, Cristina Taddei, Ver Bilano, Rodrigo M. Carrillo-Larco, Shirin Djalalinia, Shahab Khatibzadeh, Charles Lugero, Niloofar Peykari, Wan Zhu Zhang, Yuan Lu, Gretchen A. Stevens & 31 others Leanne M. Riley, Pascal Bovet, Paul Elliott, Dongfeng Gu, Nayu Ikeda, Rod T. Jackson, Michel Joffres, Andre Pascal Kengne, Tiina Laatikainen, Tai Hing Lam, Avula Laxmaiah, Jing Liu, J. Jaime Miranda, Charles K. Mondo, Hannelore K. Neuhauser, Johan Sundström, Liam Smeeth, Maroje Sorić, Mark Woodward, Majid Ezzati, Leandra Abarca-Gómez, Ziad A. Abdeen, Hanan Abdul Rahim, Niveen M. Abu-Rmeileh, Simona Costanzo, Giovanni de Gaetano, Augusto F. Di Castelnuovo, Francesco Gianfagna, Licia Iacoviello, Stefania Maggi, NCD Risk Factor Collaboration (NCD-RisC)

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)37-55
Number of pages19
JournalThe Lancet
Volume389
Issue number10064
DOIs
Publication statusPublished - Jan 7 2017

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Blood Pressure
Population
Eastern Europe
Africa South of the Sahara
Population Growth
Hypertension
Western Asia
Oceania
Central Asia
Northern Africa
Eastern Africa
Southeastern Asia
Middle East
Far East
Latin America
Population Dynamics
Chronic Renal Insufficiency

ASJC Scopus subject areas

  • Medicine(all)

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Zhou, B., Bentham, J., Di Cesare, M., Bixby, H., Danaei, G., Cowan, M. J., ... NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet, 389(10064), 37-55. https://doi.org/10.1016/S0140-6736(16)31919-5

Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. / Zhou, Bin; Bentham, James; Di Cesare, Mariachiara; Bixby, Honor; Danaei, Goodarz; Cowan, Melanie J.; Paciorek, Christopher J.; Singh, Gitanjali; Hajifathalian, Kaveh; Bennett, James E.; Taddei, Cristina; Bilano, Ver; Carrillo-Larco, Rodrigo M.; Djalalinia, Shirin; Khatibzadeh, Shahab; Lugero, Charles; Peykari, Niloofar; Zhang, Wan Zhu; Lu, Yuan; Stevens, Gretchen A.; Riley, Leanne M.; Bovet, Pascal; Elliott, Paul; Gu, Dongfeng; Ikeda, Nayu; Jackson, Rod T.; Joffres, Michel; Kengne, Andre Pascal; Laatikainen, Tiina; Lam, Tai Hing; Laxmaiah, Avula; Liu, Jing; Miranda, J. Jaime; Mondo, Charles K.; Neuhauser, Hannelore K.; Sundström, Johan; Smeeth, Liam; Sorić, Maroje; Woodward, Mark; Ezzati, Majid; Abarca-Gómez, Leandra; Abdeen, Ziad A.; Rahim, Hanan Abdul; Abu-Rmeileh, Niveen M.; Costanzo, Simona; de Gaetano, Giovanni; Di Castelnuovo, Augusto F.; Gianfagna, Francesco; Iacoviello, Licia; Maggi, Stefania; NCD Risk Factor Collaboration (NCD-RisC).

In: The Lancet, Vol. 389, No. 10064, 07.01.2017, p. 37-55.

Research output: Contribution to journalArticle

Zhou, B, Bentham, J, Di Cesare, M, Bixby, H, Danaei, G, Cowan, MJ, Paciorek, CJ, Singh, G, Hajifathalian, K, Bennett, JE, Taddei, C, Bilano, V, Carrillo-Larco, RM, Djalalinia, S, Khatibzadeh, S, Lugero, C, Peykari, N, Zhang, WZ, Lu, Y, Stevens, GA, Riley, LM, Bovet, P, Elliott, P, Gu, D, Ikeda, N, Jackson, RT, Joffres, M, Kengne, AP, Laatikainen, T, Lam, TH, Laxmaiah, A, Liu, J, Miranda, JJ, Mondo, CK, Neuhauser, HK, Sundström, J, Smeeth, L, Sorić, M, Woodward, M, Ezzati, M, Abarca-Gómez, L, Abdeen, ZA, Rahim, HA, Abu-Rmeileh, NM, Costanzo, S, de Gaetano, G, Di Castelnuovo, AF, Gianfagna, F, Iacoviello, L, Maggi, S & NCD Risk Factor Collaboration (NCD-RisC) 2017, 'Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants', The Lancet, vol. 389, no. 10064, pp. 37-55. https://doi.org/10.1016/S0140-6736(16)31919-5
Zhou, Bin ; Bentham, James ; Di Cesare, Mariachiara ; Bixby, Honor ; Danaei, Goodarz ; Cowan, Melanie J. ; Paciorek, Christopher J. ; Singh, Gitanjali ; Hajifathalian, Kaveh ; Bennett, James E. ; Taddei, Cristina ; Bilano, Ver ; Carrillo-Larco, Rodrigo M. ; Djalalinia, Shirin ; Khatibzadeh, Shahab ; Lugero, Charles ; Peykari, Niloofar ; Zhang, Wan Zhu ; Lu, Yuan ; Stevens, Gretchen A. ; Riley, Leanne M. ; Bovet, Pascal ; Elliott, Paul ; Gu, Dongfeng ; Ikeda, Nayu ; Jackson, Rod T. ; Joffres, Michel ; Kengne, Andre Pascal ; Laatikainen, Tiina ; Lam, Tai Hing ; Laxmaiah, Avula ; Liu, Jing ; Miranda, J. Jaime ; Mondo, Charles K. ; Neuhauser, Hannelore K. ; Sundström, Johan ; Smeeth, Liam ; Sorić, Maroje ; Woodward, Mark ; Ezzati, Majid ; Abarca-Gómez, Leandra ; Abdeen, Ziad A. ; Rahim, Hanan Abdul ; Abu-Rmeileh, Niveen M. ; Costanzo, Simona ; de Gaetano, Giovanni ; Di Castelnuovo, Augusto F. ; Gianfagna, Francesco ; Iacoviello, Licia ; Maggi, Stefania ; NCD Risk Factor Collaboration (NCD-RisC). / Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. In: The Lancet. 2017 ; Vol. 389, No. 10064. pp. 37-55.
@article{187d74417bb84aa08c20b77647c89416,
title = "Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants",
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.",
author = "Bin Zhou and James Bentham and {Di Cesare}, Mariachiara and Honor Bixby and Goodarz Danaei and Cowan, {Melanie J.} and Paciorek, {Christopher J.} and Gitanjali Singh and Kaveh Hajifathalian and Bennett, {James E.} and Cristina Taddei and Ver Bilano and Carrillo-Larco, {Rodrigo M.} and Shirin Djalalinia and Shahab Khatibzadeh and Charles Lugero and Niloofar Peykari and Zhang, {Wan Zhu} and Yuan Lu and Stevens, {Gretchen A.} and Riley, {Leanne M.} and Pascal Bovet and Paul Elliott and Dongfeng Gu and Nayu Ikeda and Jackson, {Rod T.} and Michel Joffres and Kengne, {Andre Pascal} and Tiina Laatikainen and Lam, {Tai Hing} and Avula Laxmaiah and Jing Liu and Miranda, {J. Jaime} and Mondo, {Charles K.} and Neuhauser, {Hannelore K.} and Johan Sundstr{\"o}m and Liam Smeeth and Maroje Sorić and Mark Woodward and Majid Ezzati and Leandra Abarca-G{\'o}mez and Abdeen, {Ziad A.} and Rahim, {Hanan Abdul} and Abu-Rmeileh, {Niveen M.} and Simona Costanzo and {de Gaetano}, Giovanni and {Di Castelnuovo}, {Augusto F.} and Francesco Gianfagna and Licia Iacoviello and Stefania Maggi and {NCD Risk Factor Collaboration (NCD-RisC)}",
year = "2017",
month = "1",
day = "7",
doi = "10.1016/S0140-6736(16)31919-5",
language = "English",
volume = "389",
pages = "37--55",
journal = "The Lancet",
issn = "0140-6736",
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TY - JOUR

T1 - Worldwide trends in blood pressure from 1975 to 2015

T2 - a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

AU - Zhou, Bin

AU - Bentham, James

AU - Di Cesare, Mariachiara

AU - Bixby, Honor

AU - Danaei, Goodarz

AU - Cowan, Melanie J.

AU - Paciorek, Christopher J.

AU - Singh, Gitanjali

AU - Hajifathalian, Kaveh

AU - Bennett, James E.

AU - Taddei, Cristina

AU - Bilano, Ver

AU - Carrillo-Larco, Rodrigo M.

AU - Djalalinia, Shirin

AU - Khatibzadeh, Shahab

AU - Lugero, Charles

AU - Peykari, Niloofar

AU - Zhang, Wan Zhu

AU - Lu, Yuan

AU - Stevens, Gretchen A.

AU - Riley, Leanne M.

AU - Bovet, Pascal

AU - Elliott, Paul

AU - Gu, Dongfeng

AU - Ikeda, Nayu

AU - Jackson, Rod T.

AU - Joffres, Michel

AU - Kengne, Andre Pascal

AU - Laatikainen, Tiina

AU - Lam, Tai Hing

AU - Laxmaiah, Avula

AU - Liu, Jing

AU - Miranda, J. Jaime

AU - Mondo, Charles K.

AU - Neuhauser, Hannelore K.

AU - Sundström, Johan

AU - Smeeth, Liam

AU - Sorić, Maroje

AU - Woodward, Mark

AU - Ezzati, Majid

AU - Abarca-Gómez, Leandra

AU - Abdeen, Ziad A.

AU - Rahim, Hanan Abdul

AU - Abu-Rmeileh, Niveen M.

AU - Costanzo, Simona

AU - de Gaetano, Giovanni

AU - Di Castelnuovo, Augusto F.

AU - Gianfagna, Francesco

AU - Iacoviello, Licia

AU - Maggi, Stefania

AU - NCD Risk Factor Collaboration (NCD-RisC)

PY - 2017/1/7

Y1 - 2017/1/7

N2 - 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.

AB - 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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U2 - 10.1016/S0140-6736(16)31919-5

DO - 10.1016/S0140-6736(16)31919-5

M3 - Article

VL - 389

SP - 37

EP - 55

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10064

ER -