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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

By June 1, 2018September 24th, 2020No Comments


International Journal of Epidemiology

NCD Risk Factor Collaboration (NCD-RisC)

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 (probit-transformed)
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 high-income 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
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.


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