Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants
Authors: Bin Zhou, James Bentham, Mariachiara Di Cesare, Honor Bixby, Goodarz Danaei, Melanie J Cowan, Christopher J Paciorek, Gitanjali Singh, Kaveh Hajifathalian, James E Bennett, Cristina Taddei, Ver Bilano, Rodrigo M Carrillo-Larco, Shirin Djalalinia, Shahab Khatibzadeh, Charles Lugero, Niloofar Peykari, Wan Zhu Zhang, Yuan Lu, Gretchen A Stevens, Leanne M Riley, Pascal Bovet, Paul Elliott, Dongfeng Gu, Nayu Ikeda, Rod T Jackson, Michel Joffres, Andre Pascal Kengne, Tiina Laatikainen, Tai Hing Lam, Avula Laxmaiah, Jing Liu, J Jaime Miranda, Charles K Mondo, Hannelore K Neuhauser, Johan Sundström, Liam Smeeth, Maroje Soric, Mark Woodward, Majid Ezzati, Leandra Abarca-Gómez, Ziad A Abdeen, Hanan Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert Adams, Wichai Aekplakorn, Kaosar Afsana, Carlos A Aguilar-Salinas, Charles Agyemang, Alireza Ahmadvand, Wolfgang Ahrens, Rajaa Al Raddadi, Rihab Al Woyatan, Mohamed M Ali, Ala'a Alkerwi, Eman Aly, Philippe Amouyel, Antoinette Amuzu, Lars Bo Andersen, Sigmund A Anderssen, Lars Ängquist, Ranjit Mohan Anjana, Daniel Ansong, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Nimmathota Arlappa, Krishna Aryal, Dominique Arveiler, Felix K Assah, Maria Cecília F Assunção, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Bontha V Babu, Suhad Bahijri, Nagalla Balakrishna, Piotr Bandosz, José R Banegas, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Aluisio J D Barros, Mauro V Barros, Iqbal Bata, Anwar M Batieha, Louise A Baur, Robert Beaglehole, Habiba Ben Romdhane, Mikhail Benet, Lowell S Benson, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K Bhargava, Yufang Bi, Mukharram Bikbov, Peter Bjerregaard, Espen Bjertness, Cecilia Björkelund, Anneke Blokstra, Simona Bo, Martin Bobak, Heiner Boeing, Jose G Boggia, Carlos P Boissonnet, Vanina Bongard, Lutgart Braeckman, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, Hermann Brenner, Lizzy M Brewster, Graziella Bruno, H B(as) Bueno-de-Mesquita, Anna Bugge, Con Burns, Michael Bursztyn, Antonio Cabrera de León, Joseph Cacciottolo, Christine Cameron, Günay Can, Ana Paula C Cândido, Vincenzo Capuano, Viviane C Cardoso, Axel C Carlsson, Maria J Carvalho, Felipe F Casanueva, Juan-Pablo Casas, Carmelo A Caserta, Snehalatha Chamukuttan, Angelique W Chan, Queenie Chan, Himanshu K Chaturvedi, Nishi Chaturvedi, Chien-Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching-Yu Cheng, Imane Cherkaoui Dekkaki, Angela Chetrit, Arnaud Chiolero, Shu-Ti Chiou, Adela Chirita-Emandi, Belong Cho, Yumi Cho, Jerzy Chudek, Renata Cifkova, Frank Claessens, Els Clays, Hans Concin, Cyrus Cooper, Rachel Cooper, Tara C Coppinger, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L Craig, Ana B Crujeiras, Juan J Cruz, Graziella D'Arrigo, Eleonora d'Orsi, Jean Dallongeville, Albertino Damasceno, Rachel Dankner, Thomas M Dantoft, Luc Dauchet, Guy De Backer, Dirk De Bacquer, Giovanni de Gaetano, Stefaan De Henauw, Delphine De Smedt, Mohan Deepa, Abbas Dehghan, Hélène Delisle, Valérie Deschamps, Klodian Dhana, Augusto F Di Castelnuovo, Juvenal Soares Dias-da-Costa, Alejandro Diaz, Ty T Dickerson, Ha T P Do, Annette J Dobson, Chiara Donfrancesco, Silvana P Donoso, Angela Döring, Kouamelan Doua, Wojciech Drygas, Virginija Dulskiene, Aleksandar Džakula, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Robert Eggertsen, Ulf Ekelund, Jalila El Ati, Ute Ellert, Paul Elliott, Roberto Elosua, Rajiv T Erasmus, Cihangir Erem, Louise Eriksen, Jorge Escobedo de la Peña, Alun Evans, David Faeh, Caroline H Fall, Farshad Farzadfar, Francisco J Felix-Redondo, Trevor S Ferguson, Daniel Fernández-Bergés, Daniel Ferrante, Marika Ferrari, Catterina Ferreccio, Jean Ferrieres, Joseph D Finn, Krista Fischer, Bernhard Föger, Leng Huat Foo, Ann-Sofie Forslund, Maria Forsner, Stephen P Fortmann, Heba M Fouad, Damian K Francis, Maria do Carmo Franco, Oscar H Franco, Guillermo Frontera, Flavio D Fuchs, Sandra C Fuchs, Yuki Fujita, Takuro Furusawa, Zbigniew Gaciong, Dickman Gareta, Sarah P Garnett, Jean-Michel Gaspoz, Magda Gasull, Louise Gates, Diana Gavrila, Johanna M Geleijnse, Anoosheh Ghasemian, Anup Ghimire, Simona Giampaoli, Francesco Gianfagna, Jonathan Giovannelli, Rebecca A Goldsmith, Helen Gonçalves, Marcela Gonzalez Gross, Juan P González Rivas, Frederic Gottrand, Sidsel Graff-Iversen, Dušan Grafnetter, Aneta Grajda, Ronald D Gregor, Tomasz Grodzicki, Anders Grøntved, Grabriella Gruden, Vera Grujic, Dongfeng Gu, Ong Peng Guan, Vilmundur Gudnason, Ramiro Guerrero, Idris Guessous, Andre L Guimaraes, Martin C Gulliford, Johanna Gunnlaugsdottir, Marc Gunter, Prakash C Gupta, Oye Gureje, Beata Gurzkowska, Laura Gutierrez, Felix Gutzwiller, Farzad Hadaegh, Jytte Halkjær, Ian R Hambleton, Rebecca Hardy, Rachakulla Harikumar, Jun Hata, Alison J Hayes, Jiang He, Marleen Elisabeth Hendriks, Ana Henriques, Leticia Hernandez Cadena, Sauli Herrala, Ramin Heshmat, Ilpo Tapani Hihtaniemi, Sai Yin Ho, Suzanne C Ho, Michael Hobbs, Albert Hofman, Gonul Horasan Dinc, Claudia M Hormiga, Bernardo L Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Yonghua Hu, José María Huerta, Abdullatif S Husseini, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, M Mohsen Ibrahim, M Arfan Ikram, Vilma E Irazola, Muhammad Islam, Vanja Ivkovic, Masanori Iwasaki, Rod T Jackson, Jeremy M Jacobs, Tazeen Jafar, Konrad Jamrozik, Imre Janszky, Grazyna Jasienska, Bojan Jelakovic, Chao Qiang Jiang, Michel Joffres, Mattias Johansson, Jost B Jonas, Torben Jørgensen, Pradeep Joshi, Anne Juolevi, Gregor Jurak, Vesna Jureša, Rudolf Kaaks, Anthony Kafatos, Ofra Kalter-Leibovici, Nor Azmi Kamaruddin, Amir Kasaeian, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Han C G Kemper, Andre Pascal Kengne, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Young-Ho Khang, Kay-Tee Khaw, Stefan Kiechl, Japhet Killewo, Jeongseon Kim, Jurate Klumbiene, Elin Kolle, Patrick Kolsteren, Paul Korrovits, Seppo Koskinen, Katsuyasu Kouda, Slawomir Koziel, Peter Lund Kristensen, Steinar Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Diana Kuh, Urho M Kujala, Krzysztof Kula, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher Larijani, Lars E Laugsand, Avula Laxmaiah, Khanh Le Nguyen Bao, Tuyen D Le, Catherine Leclercq, Jeannette Lee, Jeonghee Lee, Terho Lehtimäki, Rampal Lekhraj, Luz M León-Muñoz, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Hsien-Ho Lin, Xu Lin, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Roberto Lorbeer, Paulo A Lotufo, José Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Nuno Lunet, Per Lytsy, Guansheng Ma, Jun Ma, George L L Machado-Coelho, Suka Machi, Stefania Maggi, Dianna J Magliano, Marjeta Majer, Marcia Makdisse, Reza Malekzadeh, Rahul Malhotra, Kodavanti Mallikharjuna Rao, Sofia Malyutina, Yannis Manios, Jim I Mann, Enzo Manzato, Paula Margozzini, Pedro Marques-Vidal, Jaume Marrugat, Reynaldo Martorell, Ellisiv B Mathiesen, Alicia Matijasevich, Tandi E Matsha, Jean Claude N Mbanya, Anselmo J Mc Donald Posso, Shelly R McFarlane, Stephen T McGarvey, Stela McLachlan, Rachael M McLean, Breige A McNulty, Amir Sharifuddin Md Khir, Sounnia Mediene-Benchekor, Jurate Medzioniene, Aline Meirhaeghe, Christa Meisinger, Ana Maria B Menezes, Geetha R Menon, Indrapal I Meshram, Andres Metspalu, Jie Mi, Kairit Mikkel, Jody C Miller, Juan Francisco Miquel, Marjeta Mišigoj-Durakovic, Mostafa K Mohamed, Kazem Mohammad, Noushin Mohammadifard, Viswanathan Mohan, Muhammad Fadhli Mohd Yusoff, Niels C Møller, Dénes Molnár, Amirabbas Momenan, Charles K Mondo, Kotsedi Daniel K Monyeki, Leila B Moreira, Alain Morejon, Luis A Moreno, Karen Morgan, George Moschonis, Malgorzata Mossakowska, Aya Mostafa, Jorge Mota, Mohammad Esmaeel Motlagh, Jorge Motta, Maria L Muiesan, Martina Müller-Nurasyid, Neil Murphy, Jaakko Mursu, Vera Musil, Gabriele Nagel, Balkish M Naidu, Harunobu Nakamura, Jana Námešná, Ei Ei K Nang, Vinay B Nangia, Sameer Narake, Eva Maria Navarrete-Muñoz, Ndeye Coumba Ndiaye, William A Neal, Ilona Nenko, Flavio Nervi, Nguyen D Nguyen, Quang Ngoc Nguyen, Ramfis E Nieto-Martínez, Teemu J Niiranen, Guang Ning, Toshiharu Ninomiya, Sania Nishtar, Marianna Noale, Oscar A Noboa, Ahmad Ali Noorbala, Teresa Noorbala, Davide Noto, Mohannad Al Nsour, Dermot O'Reilly, Kyungwon Oh, Maria Teresa A Olinto, Isabel O Oliveira, Mohd Azahadi Omar, Altan Onat, Pedro Ordunez, Clive Osmond, Sergej M Ostojic, Johanna A Otero, Kim Overvad, Ellis Owusu-Dabo, Fred Michel Paccaud, Cristina Padez, Elena Pahomova, Andrzej Pajak, Domenico Palli, Luigi Palmieri, Songhomitra Panda-Jonas, Francesco Panza, Dimitrios Papandreou, Winsome R Parnell, Mahboubeh Parsaeian, Ivan Pecin, Mangesh S Pednekar, Nasheeta Peer, Petra H Peeters, Sergio Viana Peixoto, Catherine Pelletier, Markku Peltonen, Alexandre C Pereira, Rosa Marina Pérez, Annette Peters, Janina Petkeviciene, Son Thai Pham, Iris Pigeot, Hynek Pikhart, Aida Pilav, Lorenza Pilotto, Freda Pitakaka, Pedro Plans-Rubió, Maria Polakowska, Ozren Polašek, Miquel Porta, Marileen LP Portegies, Akram Pourshams, Rajendra Pradeepa, Mathur Prashant, Jacqueline F Price, Maria Puiu, Margus Punab, Radwan F Qasrawi, Mostafa Qorbani, Ivana Radic, Ricardas Radisauskas, Mahfuzar Rahman, Olli Raitakari, Manu Raj, Sudha Ramachandra Rao, Ambady Ramachandran, Elisabete Ramos, Sanjay Rampal, Daniel A Rangel Reina, Finn Rasmussen, Josep Redon, Paul Ferdinand M Reganit, Robespierre Ribeiro, Elio Riboli, Fernando Rigo, Tobias F Rinke de Wit, Raphael M Ritti-Dias, Sian M Robinson, Cynthia Robitaille, Fernando Rodríguez-Artalejo, María Rodriguez-Perez del Cristo, Laura A Rodríguez-Villamizar, Rosalba Rojas-Martinez, Annika Rosengren, Adolfo Rubinstein, Ornelas Rui, Blanca Sandra Ruiz-Betancourt, Andrea R V Russo Horimoto, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S Sachdev, Olfa Saidi, Sibel Sakarya, Benoit Salanave, Eduardo Salazar Martinez, Diego Salmerón, Veikko Salomaa, Jukka T Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Susana Sans, Diana Santos, Ina S Santos, Renata Nunes dos Santos, Rute Santos, Jouko L Saramies, Luis B Sardinha, Giselle Sarganas Margolis, Nizal Sarrafzadegan, Kai-Uwe Saum, Savvas C Savva, Marcia Scazufca, Herman Schargrodsky, Ione J Schneider, Constance Schultsz, Aletta E Schutte, Abhijit Sen, Idowu O Senbanjo, Sadaf G Sepanlou, Sanjib K Sharma, Jonathan E Shaw, Kenji Shibuya, Dong Wook Shin, Youchan Shin, Rosalynn Siantar, Abla M Sibai, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A Simons, Michael Sjöström, Sine Skovbjerg, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Margaret C Smith, Marieke B Snijder, Hung-Kwan So, Eugène Sobngwi, Stefan Söderberg, Vincenzo Solfrizzi, Emily Sonestedt, Yi Song, Thorkild IA Sørensen, Charles Sossa Jérome, Aicha Soumare, Jan A Staessen, Gregor Starc, Maria G Stathopoulou, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D Stein, George S Stergiou, Jochanan Stessman, Jutta Stieber, Doris Stöckl, Tanja Stocks, Jakub Stokwiszewski, Karien Stronks, Maria Wany Strufaldi, Chien-An Sun, Johan Sundström, Yn-Tz Sung, Paibul Suriyawongpaisal, Rody G Sy, E Shyong Tai, Mari-Liis Tammesoo, Abdonas Tamosiunas, Line Tang, Xun Tang, Frank Tanser, Yong Tao, Mohammed Rasoul Tarawneh, Carolina B Tarqui-Mamani, Anne Taylor, Holger Theobald, Lutgarde Thijs, Betina H Thuesen, Anne Tjonneland, Hanna K Tolonen, Janne S Tolstrup, Murat Topbas, Roman Topór-Madry, María José Tormo, Maties Torrent, Pierre Traissac, Dimitrios Trichopoulos, Antonia Trichopoulou, Oanh T H Trinh, Atul Trivedi, Lechaba Tshepo, Marshall K Tulloch-Reid, Tomi-Pekka Tuomainen, Jaakko Tuomilehto, Maria L Turley, Per Tynelius, Christophe Tzourio, Peter Ueda, Eunice Ugel, Hanno Ulmer, Hannu M T Uusitalo, Gonzalo Valdivia, Damaskini Valvi, Yvonne T van der Schouw, Koen Van Herck, Lenie van Rossem, Irene GM van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Lars Vatten, Tomas Vega, Gustavo Velasquez-Melendez, Giovanni Veronesi, W M Monique Verschuren, Roosmarijn Verstraeten, Cesar G Victora, Lucie Viet, Eira Viikari-Juntura, Paolo Vineis, Jesus Vioque, Jyrki K Virtanen, Sophie Visvikis-Siest, Bharathi Viswanathan, Peter Vollenweider, Sari Voutilainen, Ana Vrdoljak, Martine Vrijheid, Alisha N Wade, Aline Wagner, Janette Walton, Wan Nazaimoon Wan Mohamud, Ming-Dong Wang, Qian Wang, Ya Xing Wang, S Goya Wannamethee, Nicholas Wareham, Niels Wedderkopp, Deepa Weerasekera, Peter H Whincup, Kurt Widhalm, Indah S Widyahening, Andrzej Wiecek, Alet H Wijga, Rainford J Wilks, Johann Willeit, Peter Willeit, Emmanuel A Williams, Tom Wilsgaard, Bogdan Wojtyniak, Tien Yin Wong, Roy A Wong-McClure, Jean Woo, Mark Woodward, Aleksander Giwercman Wu, Frederick C Wu, Shou Ling Wu, Haiquan Xu, Weili Yan, Xiaoguang Yang, Xingwang Ye, Panayiotis K Yiallouros, Akihiro Yoshihara, Novie O Younger-Coleman, Ahmad F Yusoff, Muhammad Fadhli M Yusoff, Sabina Zambon, Tomasz Zdrojewski, Yi Zeng, Dong Zhao, Wenhua Zhao, Yingffeng Zheng, Dan Zhu, Esther Zimmermann, Julio Zuñiga Cisneros
Journal: The Lancet (2016)

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.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.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.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.Wellcome Trust.