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. 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

Mohammad H Forouzanfar  1 Patrick Liu  1 Gregory A Roth  1 Marie Ng  1 Stan Biryukov  1 Laurie Marczak  1 Lily Alexander  1 Kara Estep  1 Kalkidan Hassen Abate  2 Tomi F Akinyemiju  3 Raghib Ali  4 Nelson Alvis-Guzman  5 Peter Azzopardi  6 Amitava Banerjee  7 Till Bärnighausen  8 Arindam Basu  9 Tolesa Bekele  10 Derrick A Bennett  4 Sibhatu Biadgilign  11 Ferrán Catalá-López  12 Valery L Feigin  13 Joao C Fernandes  14 Florian Fischer  15 Alemseged Aregay Gebru  16 Philimon Gona  17 Rajeev Gupta  18 Graeme J Hankey  19 Jost B Jonas  20 Suzanne E Judd  21 Young-Ho Khang  22 Ardeshir Khosravi  23 Yun Jin Kim  24 Ruth W Kimokoti  25 Yoshihiro Kokubo  26 Dhaval Kolte  27 Alan Lopez  28 Paulo A Lotufo  29 Reza Malekzadeh  30 Yohannes Adama Melaku  31 George A Mensah  32 Awoke Misganaw  1 Ali H Mokdad  1 Andrew E Moran  33 Haseeb Nawaz  34 Bruce Neal  35 Frida Namnyak Ngalesoni  36 Takayoshi Ohkubo  37 Farshad Pourmalek  38 Anwar Rafay  39 Rajesh Kumar Rai  40 David Rojas-Rueda  41 Uchechukwu K Sampson  42 Itamar S Santos  43 Monika Sawhney  44 Aletta E Schutte  45 Sadaf G Sepanlou  30 Girma Temam Shifa  46 Ivy Shiue  47 Bemnet Amare Tedla  48 Amanda G Thrift  49 Marcello Tonelli  50 Thomas Truelsen  51 Nikolaos Tsilimparis  52 Kingsley Nnanna Ukwaja  53 Olalekan A Uthman  54 Tommi Vasankari  55 Narayanaswamy Venketasubramanian  56 Vasiliy Victorovich Vlassov  57 Theo Vos  1 Ronny Westerman  58 Lijing L Yan  59 Yuichiro Yano  60 Naohiro Yonemoto  61 Maysaa El Sayed Zaki  62 Christopher J L Murray  1
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Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 Mm Hg, 1990-2015

Mohammad H Forouzanfar et al. JAMA. .
Free article

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Abstract

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

Objective: 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.

Design: 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.

Results: 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.

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