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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

Zhou, B and Bentham, J and Di Cesare, M and Bixby, H and Danaei, G and Cowan, MJ and Paciorek, CJ and Singh, G and Hajifathalian, K and Bennett, JE and Taddei, C and Bilano, V and Carrillo-Larco, RM and Djalalinia, S and Khatibzadeh, S and Lugero, C and Peykari, N and Zhang, WZ and Lu, Y and Stevens, GA and Riley, LM and Bovet, P and Elliott, P and Gu, D and Ikeda, N and Jackson, RT and Joffres, M and Kengne, AP and Laatikainen, T and Lam, TH and Laxmaiah, A and Liu, J and Miranda, JJ and Mondo, CK and Neuhauser, HK and Sundström, J and Smeeth, L and Soric, M and Woodward, M and Ezzati, M and Abarca-Gómez, L and Abdeen, ZA and Rahim, HA and Abu-Rmeileh, NM and Acosta-Cazares, B and Adams, R and Aekplakorn, W and Afsana, K and Aguilar-Salinas, CA and Agyemang, C and Ahmadvand, A and Ahrens, W and Al Raddadi, R and Al Woyatan, R and Ali, MM and Alkerwi, A and Aly, E and Amouyel, P and Amuzu, A and Andersen, LB and Anderssen, SA and Ängquist, L and Anjana, RM and Ansong, D and Aounallah-Skhiri, H and Araújo, J and Ariansen, I and Aris, T and Arlappa, N and Aryal, K and Arveiler, D and Assah, FK and Assun ao, MCF and Avdicová, M and Azevedo, A and Azizi, F and Babu, BV and Bahijri, S and Balakrishna, N and Bandosz, P and Banegas, JR and Barbagallo, CM and Barceló, A and Barkat, A and Barros, AJD and Barros, MV and Bata, I and Batieha, AM and Baur, LA and Beaglehole, R and Romdhane, HB and Benet, M and Benson, LS and Bernabe-Ortiz, A and Bernotiene, G and Bettiol, H and Bhagyalaxmi, A and Bharadwaj, S and Bhargava, SK and Bi, Y and Bikbov, M and Bjerregaard, P and Bjertness, E and Björkelund, C and Blokstra, A and Bo, S and Bobak, M and Boeing, H and Boggia, JG and Boissonnet, CP and Bongard, V and Braeckman, L and Brajkovich, I and Branca, F and Breckenkamp, J and Brenner, H and Brewster, LM and Bruno, G and Bueno-de-Mesquita, HB and Bugge, A and Burns, C and Bursztyn, M and de León, AC and Cacciottolo, J and Cameron, C and Can, G and Cândido, APC and Capuano, V and Cardoso, VC and Carlsson, AC and Carvalho, MJ and Casanueva, FF and Casas, J-P and Caserta, CA and Chamukuttan, S and Chan, AW and Chan, Q and Chaturvedi, HK and Chaturvedi, N and Chen, C-J and Chen, F and Chen, H and Chen, S and Chen, Z and Cheng, C-Y and Dekkaki, IC and Chetrit, A and Chiolero, A and Chiou, S-T and Chirita-Emandi, A and Cho, B and Cho, Y and Chudek, J and Cifkova, R and Claessens, F and Clays, E and Concin, H and Cooper, C and Cooper, R and Coppinger, TC and Costanzo, S and Cottel, D and Cowell, C and Craig, CL and Crujeiras, AB and Cruz, JJ and D Arrigo, G and d Orsi, E and Dallongeville, J and Damasceno, A and Danaei, G and Dankner, R and Dantoft, TM and Dauchet, L and De Backer, G and De Bacquer, D and de Gaetano, G and De Henauw, S and De Smedt, D and Deepa, M and Dehghan, A and Delisle, H and Deschamps, V and Dhana, K and Di Castelnuovo, AF and Dias-da-Costa, JS and Diaz, A and Dickerson, TT and Do, HTP and Dobson, AJ and Donfrancesco, C and Donoso, SP and Döring, A and Doua, K and Drygas, W and Dulskiene, V and D akula, A and Dzerve, V and Dziankowska-Zaborszczyk, E and Eggertsen, R and Ekelund, U and El Ati, J and Ellert, U and Elliott, P and Elosua, R and Erasmus, RT and Erem, C and Eriksen, L and Escobedo-de la Pe na, J and Evans, A and Faeh, D and Fall, CH and Farzadfar, F and Felix-Redondo, FJ and Ferguson, TS and Fernández-Bergés, D and Ferrante, D and Ferrari, M and Ferreccio, C and Ferrieres, J and Finn, JD and Fischer, K and Föger, B and Foo, LH and Forslund, A-S and Forsner, M and Fortmann, SP and Fouad, HM and Francis, DK and do Carmo Franco, M and Franco, OH and Frontera, G and Fuchs, FD and Fuchs, SC and Fujita, Y and Furusawa, T and Gaciong, Z and Gareta, D and Garnett, SP and Gaspoz, J-M and Gasull, M and Gates, L and Gavrila, D and Geleijnse, JM and Ghasemian, A and Ghimire, A and Giampaoli, S and Gianfagna, F and Giovannelli, J and Goldsmith, RA and Gon alves, H and Gross, MG and González Rivas, JP and Gottrand, F and Graff-Iversen, S and Grafnetter, D and Grajda, A and Gregor, RD and Grodzicki, T and Grøntved, A and Gruden, G and Grujic, V and Gu, D and Guan, OP and Gudnason, V and Guerrero, R and Guessous, I and Guimaraes, AL and Gulliford, MC and Gunnlaugsdottir, J and Gunter, M and Gupta, PC and Gureje, O and Gurzkowska, B and Gutierrez, L and Gutzwiller, F and Hadaegh, F and Halkj r, J and Hambleton, IR and Hardy, R and Harikumar, R and Hata, J and Hayes, AJ and He, J and Hendriks, ME and Henriques, A and Cadena, LH and Herqutanto and Herrala, S and Heshmat, R and Hihtaniemi, IT and Ho, SY and Ho, SC and Hobbs, M and Hofman, A and Dinc, GH and Hormiga, CM and Horta, BL and Houti, L and Howitt, C and Htay, TT and Htet, AS and Hu, Y and Huerta, JM and Husseini, AS and Huybrechts, I and Hwalla, N and Iacoviello, L and Iannone, AG and Ibrahim, MM and Ikram, MA and Irazola, VE and Islam, M and Ivkovic, V and Iwasaki, M and Jackson, RT and Jacobs, JM and Jafar, T and Jamrozik, K and Janszky, I and Jasienska, G and Jelakovic, B and Jiang, CQ and Joffres, M and Johansson, M and Jonas, JB and J rgensen, T and Joshi, P and Juolevi, A and Jurak, G and Jure a, V and Kaaks, R and Kafatos, A and Kalter-Leibovici, O and Kamaruddin, NA and Kasaeian, A and Katz, J and Kauhanen, J and Kaur, P and Kavousi, M and Kazakbaeva, G and Keil, U and Boker, LK and Keinänen-Kiukaanniemi, S and Kelishadi, R and Kemper, HCG and Kengne, AP and Kersting, M and Key, T and Khader, YS and Khalili, D and Khang, Y-H and Khaw, K-T and Kiechl, S and Killewo, J and Kim, J and Klumbiene, J and Kolle, E and Kolsteren, P and Korrovits, P and Koskinen, S and Kouda, K and Koziel, S and Kristensen, PL and Krokstad, S and Kromhout, D and Kruger, HS and Kubinova, R and Kuciene, R and Kuh, D and Kujala, UM and Kula, K and Kulaga, Z and Krishna Kumar, R and Kurjata, P and Kusuma, YS and Kuulasmaa, K and Kyobutungi, C and Laatikainen, T and Lachat, C and Lam, TH and Landrove, O and Lanska, V and Lappas, G and Larijani, B and Laugsand, LE and Laxmaiah, A and Le Nguyen Bao, K and Le, TD and Leclercq, C and Lee, J and Lee, J and Lehtimäki, T and Lekhraj, R and León-Mu noz, LM and Levitt, NS and Li, Y and Lilly, CL and Lim, W-Y and Lima-Costa, MF and Lin, H-H and Lin, X and Linneberg, A and Lissner, L and Litwin, M and Lorbeer, R and Lotufo, PA and Lozano, JE and Luksiene, D and Lundqvist, A and Lunet, N and Lytsy, P and Ma, G and Ma, J and Machado-Coelho, GLL and Machi, S and Maggi, S and Magliano, DJ and Majer, M and Makdisse, M and Malekzadeh, R and Malhotra, R and Rao, KM and Malyutina, S and Manios, Y and Mann, JI and Manzato, E and Margozzini, P and Marques-Vidal, P and Marrugat, J and Martorell, R and Mathiesen, EB and Matijasevich, A and Matsha, TE and Mbanya, JCN and McDonald Posso, AJ and McFarlane, SR and McGarvey, ST and McLachlan, S and McLean, RM and McNulty, BA and MdKhir, AS and Mediene-Benchekor, S and Medzioniene, J and Meirhaeghe, A and Meisinger, C and Menezes, AMB and Menon, GR and Meshram, II and Metspalu, A and Mi, J and Mikkel, K and Miller, JC and Miquel, JF and Mi igoj-Durakovic, M and Mohamed, MK and Mohammad, K and Mohammadifard, N and Mohan, V and Mohd Yusoff, MF and M ller, NC and Molnár, D and Momenan, A and Mondo, CK and Monyeki, KDK and Moreira, LB and Morejon, A and Moreno, LA and Morgan, K and Moschonis, G and Mossakowska, M and Mostafa, A and Mota, J and Motlagh, ME and Motta, J and Muiesan, ML and Müller-Nurasyid, M and Murphy, N and Mursu, J and Musil, V and Nagel, G and Naidu, BM and Nakamura, H and Náme ná, J and Nang, EEK and Nangia, VB and Narake, S and Navarrete-Mu noz, EM and Ndiaye, NC and Neal, WA and Nenko, I and Nervi, F and Nguyen, ND and Nguyen, QN and Nieto-Martínez, RE and Niiranen, TJ and Ning, G and Ninomiya, T and Nishtar, S and Noale, M and Noboa, OA and Noorbala, AA and Norat, T and Noto, D and Al Nsour, M and O Reilly, D and Oh, K and Olinto, MTA and Oliveira, IO and Omar, MA and Onat, A and Ordunez, P and Osmond, C and Ostojic, SM and Otero, JA and Overvad, K and Owusu-Dabo, E and Paccaud, FM and Padez, C and Pahomova, E and Pajak, A and Palli, D and Palmieri, L and Panda-Jonas, S and Panza, F and Papandreou, D and Parnell, WR and Parsaeian, M and Pecin, I and Pednekar, MS and Peer, N and Peeters, PH and Peixoto, SV and Pelletier, C and Peltonen, M and Pereira, AC and Pérez, RM and Peters, A and Petkeviciene, J and Pham, ST and Pigeot, I and Pikhart, H and Pilav, A and Pilotto, L and Pitakaka, F and Plans-Rubió, P and Polakowska, M and Pola ek, O and Porta, M and Portegies, MLP and Pourshams, A and Pradeepa, R and Prashant, M and Price, JF and Puiu, M and Punab, M and Qasrawi, RF and Qorbani, M and Radic, I and Radisauskas, R and Rahman, M and Raitakari, O and Raj, M and Rao, SR and Ramachandran, A and Ramos, E and Rampal, S and Rangel Reina, DA and Rasmussen, F and Redon, J and Reganit, PFM and Ribeiro, R and Riboli, E and Rigo, F and Rinke de Wit, TF and Ritti-Dias, RM and Robinson, SM and Robitaille, C and Rodríguez-Artalejo, F and del Cristo Rodriguez-Perez, M and Rodríguez-Villamizar, LA and Rojas-Martinez, R and Rosengren, A and Rubinstein, A and Rui, O and Ruiz-Betancourt, BS and Russo Horimoto, ARV and Rutkowski, M and Sabanayagam, C and Sachdev, HS and Saidi, O and Sakarya, S and Salanave, B and Martinez, ES and Salmerón, D and Salomaa, V and Salonen, JT and Salvetti, M and Sánchez-Abanto, J and Sans, S and Santos, D and Santos, IS and dos Santos, RN and Santos, R and Saramies, JL and Sardinha, LB and Margolis, GS and Sarrafzadegan, N and Saum, K-U and Savva, SC and Scazufca, M and Schargrodsky, H and Schneider, IJ and Schultsz, C and Schutte, AE and Schutte, AE and Sen, A and Senbanjo, IO and Sepanlou, SG and Sharma, SK and Shaw, JE and Shibuya, K and Shin, DW and Shin, Y and Siantar, R and Sibai, AM and Santos Silva, DA and Simon, M and Simons, J and Simons, LA and Sjöström, M and Skovbjerg, S and Slowikowska-Hilczer, J and Slusarczyk, P and Smeeth, L and Smith, MC and Snijder, MB and So, H-K and Sobngwi, E and Söderberg, S and Solfrizzi, V and Sonestedt, E and Song, Y and S rensen, TIA and Soric, M and Jérome, CS and Soumare, A and Staessen, JA and Starc, G and Stathopoulou, MG and Stavreski, B and Steene-Johannessen, J and Stehle, P and Stein, AD and Stergiou, GS and Stessman, J and Stieber, J and Stöckl, D and Stocks, T and Stokwiszewski, J and Stronks, K and Strufaldi, MW and Sun, C-A and Sung, Y-T and Suriyawongpaisal, P and Sy, RG and Tai, ES and Tammesoo, M-L and Tamosiunas, A and Tang, L and Tang, X and Tanser, F and Tao, Y and Tarawneh, MR and Tarqui-Mamani, CB and Taylor, A and Theobald, H and Thijs, L and Thuesen, BH and Tjonneland, A and Tolonen, HK and Tolstrup, JS and Topbas, M and Topór-Madry, R and Tormo, MJ and Torrent, M and Traissac, P and Trichopoulos, D and Trichopoulou, A and Trinh, OTH and Trivedi, A and Tshepo, L and Tulloch-Reid, MK and Tuomainen, T-P and Tuomilehto, J and Turley, ML and Tynelius, P and Tzourio, C and Ueda, P and Ugel, E and Ulmer, H and Uusitalo, HMT and Valdivia, G and Valvi, D and van der Schouw, YT and Van Herck, K and van Rossem, L and van Valkengoed, IGM and Vanderschueren, D and Vanuzzo, D and Vatten, L and Vega, T and Velasquez-Melendez, G and Veronesi, G and Verschuren, WMM and Verstraeten, R and Victora, CG and Viet, L and Viikari-Juntura, E and Vineis, P and Vioque, J and Virtanen, JK and Visvikis-Siest, S and Viswanathan, B and Vollenweider, P and Voutilainen, S and Vrdoljak, A and Vrijheid, M and Wade, AN and Wagner, A and Walton, J and Wan Mohamud, WN and Wang, M-D and Wang, Q and Wang, YX and Wannamethee, SG and Wareham, N and Wederkopp, N and Weerasekera, D and Whincup, PH and Widhalm, K and Widyahening, IS and Wiecek, A and Wijga, AH and Wilks, RJ and Willeit, J and Willeit, P and Williams, EA and Wilsgaard, T and Wojtyniak, B and Wong, TY and Wong-McClure, RA and Woo, J and Woodward, M and Woodward, M and Wu, AG and Wu, FC and Wu, SL and Xu, H and Yan, W and Yang, X and Ye, X and Yiallouros, PK and Yoshihara, A and Younger-Coleman, NO and Yusoff, AF and Yusoff, MFM and Zambon, S and Zdrojewski, T and Zeng, Y and Zeng, Y and Zhao, D and Zhao, W and Zheng, Y and Zhu, D and Zimmermann, E and Cisneros, JZ (2017) Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet, 389 (10064). pp. 37-55. ISSN 0140-6736


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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 higher. 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.

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