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

By January 1, 2017September 24th, 2020No Comments


The Lancet

NCD Risk Factor Collaboration (NCD-RisC)

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
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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