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Lancet. 2017 Jan 7;389(10064):37-55. doi: 10.1016/S0140-6736(16)31919-5. Epub 2016 Nov 16.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants.

Collaborators (772)

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, Soric M, Woodward M, Ezzati M, Abarca-Gómez L, Abdeen ZA, Rahim HA, Abu-Rmeileh NM, Acosta-Cazares B, Adams R, Aekplakorn W, Afsana K, Aguilar-Salinas CA, Agyemang C, Ahmadvand A, Ahrens W, Al Raddadi R, Al Woyatan R, Ali MM, Alkerwi A, Aly E, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Ängquist L, Anjana RM, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arlappa N, Aryal K, Arveiler D, Assah FK, Assunção MCF, Avdicová M, Azevedo A, Azizi F, Babu BV, Bahijri S, Balakrishna N, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MV, Bata I, Batieha AM, Baur LA, Beaglehole R, Romdhane HB, Benet M, Benson LS, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi Y, Bikbov M, Bjerregaard P, Bjertness E, Björkelund C, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bongard V, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Bruno G, Bueno-de-Mesquita HBA, Bugge A, Burns C, Bursztyn M, de León AC, Cacciottolo J, Cameron C, Can G, Cândido APC, Capuano V, Cardoso VC, Carlsson AC, Carvalho MJ, Casanueva FF, Casas JP, Caserta CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Dekkaki IC, Chetrit A, Chiolero A, Chiou ST, Chirita-Emandi A, Cho B, Cho Y, Chudek J, Cifkova R, Claessens F, Clays E, Concin H, Cooper C, Cooper R, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crujeiras AB, Cruz JJ, D'Arrigo G, d'Orsi E, Dallongeville J, Damasceno A, Dankner R, Dantoft TM, Dauchet L, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, De Smedt D, Deepa M, Dehghan A, Delisle H, Deschamps V, Dhana K, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Doua K, Drygas W, Dulskiene V, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eggertsen R, Ekelund U, El Ati J, Ellert U, Elliott P, Elosua R, Erasmus RT, Erem C, Eriksen L, de la Peña JE, Evans A, Faeh D, Fall CH, Farzadfar F, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrante D, Ferrari M, Ferreccio C, Ferrieres J, Finn JD, Fischer K, Föger B, Foo LH, Forslund AS, Forsner M, Fortmann SP, Fouad HM, Francis DK, Franco MDC, Franco OH, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Furusawa T, Gaciong Z, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gates L, Gavrila D, Geleijnse JM, Ghasemian A, Ghimire A, Giampaoli S, Gianfagna F, Giovannelli J, Goldsmith RA, Gonçalves H, Gross MG, Rivas JPG, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Gregor RD, Grodzicki T, Grøntved A, Gruden G, Grujic V, Gu D, Guan OP, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter M, Gupta PC, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Hadaegh F, Halkjær J, Hambleton IR, Hardy R, Harikumar R, Hata J, Hayes AJ, He J, Hendriks ME, Henriques A, Cadena LH, Herrala S, Heshmat R, Hihtaniemi IT, Ho SY, Ho SC, Hobbs M, Hofman A, Dinc GH, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Hu Y, Huerta JM, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ikram MA, Irazola VE, Islam M, Ivkovic V, Iwasaki M, Jackson RT, Jacobs JM, Jafar T, Jamrozik K, Janszky I, Jasienska G, Jelakovic B, Jiang CQ, Joffres M, Johansson M, Jonas JB, Jørgensen T, Joshi P, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kalter-Leibovici O, Kamaruddin NA, Kasaeian A, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Kengne AP, Kersting M, Key T, Khader YS, Khalili D, Khang YH, Khaw KT, Kiechl S, Killewo J, Kim J, Klumbiene J, Kolle E, Kolsteren P, Korrovits P, Koskinen S, Kouda K, Koziel S, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kuh D, Kujala UM, Kula K, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Laugsand LE, Laxmaiah A, Bao KLN, Le TD, Leclercq C, Lee J, Lee J, Lehtimäki T, Lekhraj R, León-Muñoz LM, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Linneberg A, Lissner L, Litwin M, Lorbeer R, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lytsy P, Ma G, Ma J, Machado-Coelho GLL, Machi S, Maggi S, Magliano DJ, Majer M, Makdisse M, Malekzadeh R, Malhotra R, Rao KM, Malyutina S, Manios Y, Mann JI, Manzato E, Margozzini P, Marques-Vidal P, Marrugat J, Martorell R, Mathiesen EB, Matijasevich A, Matsha TE, Mbanya JCN, Posso AJMD, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McNulty BA, Khir ASM, Mediene-Benchekor S, Medzioniene J, Meirhaeghe A, Meisinger C, Menezes AMB, Menon GR, Meshram II, Metspalu A, Mi J, Mikkel K, Miller JC, Miquel JF, Mišigoj-Durakovic M, Mohamed MK, Mohammad K, Mohammadifard N, Mohan V, Yusoff MFM, Møller NC, Molnár D, Momenan A, Mondo CK, Monyeki KDK, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mota J, Motlagh ME, Motta J, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musil V, Nagel G, Naidu BM, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Navarrete-Muñoz EM, Ndiaye NC, Neal WA, Nenko I, Nervi F, Nguyen ND, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Ning G, Ninomiya T, Nishtar S, Noale M, Noboa OA, Noorbala AA, Noorbala T, Noto D, Al Nsour M, O'Reilly D, Oh K, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ordunez P, Osmond C, Ostojic SM, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Pajak A, Palli D, Palmieri L, Panda-Jonas S, Panza F, Papandreou D, Parnell WR, Parsaeian M, Pecin I, Pednekar MS, Peer N, Peeters PH, Peixoto SV, Pelletier C, Peltonen M, Pereira AC, Pérez RM, Peters A, Petkeviciene J, Pham ST, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Plans-Rubió P, Polakowska M, Polašek O, Porta M, Portegies ML, Pourshams A, Pradeepa R, Prashant M, Price JF, Puiu M, Punab M, Qasrawi RF, Qorbani M, Radic I, Radisauskas R, Rahman M, Raitakari O, Raj M, Rao SR, Ramachandran A, Ramos E, Rampal S, Reina DAR, Rasmussen F, Redon J, Reganit PFM, Ribeiro R, Riboli E, Rigo F, de Wit TFR, Ritti-Dias RM, Robinson SM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez Del Cristo M, Rodríguez-Villamizar LA, Rojas-Martinez R, Rosengren A, Rubinstein A, Rui O, Ruiz-Betancourt BS, Horimoto ARVR, Rutkowski M, Sabanayagam C, Sachdev HS, Saidi O, Sakarya S, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos D, Santos IS, Dos Santos RN, Santos R, Saramies JL, Sardinha LB, Margolis GS, Sarrafzadegan N, Saum KU, Savva SC, Scazufca M, Schargrodsky H, Schneider IJ, Schultsz C, Schutte AE, Sen A, Senbanjo IO, Sepanlou SG, Sharma SK, Shaw JE, Shibuya K, Shin DW, Shin Y, Siantar R, Sibai AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Skovbjerg S, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Smith MC, Snijder MB, So HK, Sobngwi E, Söderberg S, Solfrizzi V, Sonestedt E, Song Y, Sørensen TI, Jérome CS, Soumare A, Staessen JA, Starc G, Stathopoulou MG, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Sun CA, Sundström J, Sung YT, Suriyawongpaisal P, Sy RG, Tai ES, Tammesoo ML, Tamosiunas A, Tang L, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Theobald H, Thijs L, Thuesen BH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Torrent M, Traissac P, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tulloch-Reid MK, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van der Schouw YT, Van Herck K, van Rossem L, van Valkengoed IG, Vanderschueren D, Vanuzzo D, Vatten L, Vega T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Viikari-Juntura E, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vollenweider P, Voutilainen S, Vrdoljak A, Vrijheid M, Wade AN, Wagner A, Walton J, Mohamud WNW, Wang MD, Wang Q, Wang YX, Wannamethee SG, Wareham N, Wederkopp N, Weerasekera D, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong TY, Wong-McClure RA, Woo J, Woodward M, Wu AG, Wu FC, Wu SL, Xu H, Yan W, Yang X, Ye X, Yiallouros PK, Yoshihara A, Younger-Coleman NO, Yusoff AF, Yusoff MFM, Zambon S, Zdrojewski T, Zeng Y, Zhao D, Zhao W, Zheng Y, Zhu D, Zimmermann E, Zuñiga Cisneros J.

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.

PMID:
27863813
PMCID:
PMC5220163
DOI:
10.1016/S0140-6736(16)31919-5
[Indexed for MEDLINE]
Free PMC Article

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