ArticlesNational, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants
Introduction
High blood pressure is the leading risk factor for cardiovascular disease mortality, causing more than 7 million deaths every year worldwide.1, 2, 3 Multicountry studies4, 5, 6, 7 have shown large differences in mean population blood pressure, associated with variations in adiposity and dietary salt. Studies in a few countries and communities with repeated data show that change in population blood pressure can range from remaining almost unchanged to 10 mm Hg per decade.4, 8, 9, 10, 11, 12, 13, 14, 15
Reliable information about trends in blood pressure is needed to understand its dietary, lifestyle, and pharmacological determinants within populations; set intervention priorities; and evaluate national programmes. Despite decades of research on health consequences of high blood pressure and benefits of interventions, our knowledge of trends, with few exceptions,10, 11, 12, 16, 17, 18 is based on cohort and community studies, mainly from high-income countries.4, 8, 13, 19, 20, 21, 22, 23 Previous analyses reviewed published studies to estimate mean blood pressure or hypertension prevalence worldwide.24, 25 These studies advanced our knowledge of worldwide levels, but were based on only a few dozen studies, did not assess time trends, did not explicitly address missing data for entire countries or for older ages, combined data from nationally representative surveys with subnational and community studies without distinguishing them, and did not account for all sources of uncertainty including missing and older country data. Many health examination surveys have measured blood pressure, providing an opportunity to systematically and comprehensively assess regional and national trends.
We reviewed and accessed unpublished and published studies to collate comprehensive data for blood pressure. We developed and applied statistical methods to systematically address measurement comparability, missing data, non-linear trends, age patterns, and national versus subnational and community representativeness. With these data and methods, we estimated blood pressure trends and their uncertainties by country.
Section snippets
Study design
We estimated 1980–2008 trends in mean systolic blood pressure (SBP) and their uncertainties, by sex, for 199 countries and territories in 21 subregions of the Global Burden of Diseases, Injuries, and Risk Factors study, which are grouped into seven merged regions (webappendix p 21). We estimated trends in SBP, rather than diastolic blood pressure (DBP), because prospective studies1, 26 strongly suggest that SBP is a better predictor of cardiovascular disease risk, especially in older adults
Results
Our analysis included 786 country-years with 5·4 million participants (figure 1). 406 country-years were from 28 high-income countries and 380 from 107 low-income and middle-income countries. High-income subregions of east Asia, North America, and western Europe had the most data per country (webappendix pp 67–69). National surveys provided 20% of all data, subnational studies 15%, and community studies the remainder (webappendix pp 70–71). Japan had the most national data with 28 years,
Discussion
We systematically analysed health examination surveys and epidemiological studies, and estimated worldwide trends in SBP, the leading cardiovascular risk factor. We noted that, after standardising for population age structure, mean SBP decreased by about 1 mm Hg per decade for men and women between 1980 and 2008. The estimated trends changed the age-standardised prevalence of uncontrolled hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg) from 33% (95% CI 28–39) in 1980 to 29% (27–31) in 2008 in
References (44)
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Lancet
(2002)- et al.
Selected major risk factors and global and regional burden of disease
Lancet
(2002) Global health risks: mortality and burden of disease attributable to selected major risks
(2009)- et al.
Trends in coronary risk factors in the WHO MONICA project
Int J Epidemiol
(2001) - et al.
Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group
BMJ
(1996) - et al.
Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study
J Am Diet Assoc
(2010) - et al.
Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States
JAMA
(2003) - et al.
Ten year trends in chronic disease risk factors in the Republic of Karelia, Russia
Eur J Public Health
(2008) - et al.
Twenty-year trends in coronary risk factors in north Karelia and in other areas of Finland
Int J Epidemiol
(1994) - et al.
Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986–2002
Bull World Health Organ
(2008)
Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States
Circulation
Improvement in hypertension management in England: results from the Health Survey for England 2003
J Hypertens
Prevalence, awareness and treatment of hypertension in Finland during 1982–2007
J Hypertens
Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/8. Czech MONICA and Czech post-MONICA
Atherosclerosis
National trends in risk factors for cardiovascular disease in Germany
Prev Med
Divergent fifteen-year trends in traditional and cardiometabolic risk factors of cardiovascular diseases in the Seychelles
Cardiovasc Diabetol
Trends in cerebrovascular disease mortality in Singapore: 1970–1994
Int J Epidemiol
Cardiovascular risk prevalence, awareness, treatment, and control from 1998 to 2007 in Koreans
Asia Pac J Clin Nutr
Long-term trends in major cardiovascular risk factors in cohorts of aging men in the European cohorts of the Seven Countries Study
Aging Clin Exp Res
Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982–1992
J Epidemiol Community Health
Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults
J Hum Hypertens
The 21-year follow-up of the Cardiovascular Risk in Young Finns Study: risk factor levels, secular trends and east-west difference
J Intern Med
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These authors contributed equally to the research and manuscript and are listed in alphabetical order
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