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JAMA. 2017 Jan 10;317(2):165-182. doi: 10.1001/jama.2016.19043.

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

Author information

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



Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions.


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.


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.


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.

[PubMed - indexed for MEDLINE]
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