Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015
Open accessAbstract
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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Over 50% of heart disease, stroke, and heart failure are caused by increased blood pressure.
“Over 50% of heart disease, stroke, and heart failure are caused by increased blood pressure.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [7]
Hypertension causes over 40% of deaths in people with diabetes and is also a leading risk for fetal and maternal death in pregnancy, dementia, and renal failure (particularly in people of African ancestry) and can cause blindness.
“Hypertension causes over 40% of deaths in people with dia -betes 11 and is also a leading risk for fetal and maternal death in pregnancy, dementia, and renal failure (particularly in people of African ancestry) and can cause blindness.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [7]
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Self-citation
- Authors
- Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L., Alexander, L., Estep, K., Hassen Abate, K., Akinyemiju, T. F., Ali, R., Alvis-Guzman, N., Azzopardi, P., Banerjee, A., Bärnighausen, T., Basu, A., Bekele, T., Bennett, D. A., Biadgilign, S., Catalá-López, F., Feigin, V. L., Fernandes, J. C., Fischer, F., Gebru, A. A., Gona, P., Gupta, R., Hankey, G. J., Jonas, J. B., Judd, S. E., Khang, Y.-H., Khosravi, A., Kim, Y. J., Kimokoti, R. W., Kokubo, Y., Kolte, D., Lopez, A., Lotufo, P. A., Malekzadeh, R., Melaku, Y. A., Mensah, G. A., Misganaw, A., Mokdad, A. H., Moran, A. E., Nawaz, H., Neal, B., Ngalesoni, F. N., Ohkubo, T., Pourmalek, F., Rafay, A., Rai, R. K., Rojas-Rueda, D., Sampson, U. K., Santos, I. S., Sawhney, M., Schutte, A. E., Sepanlou, S. G., Shifa, G. T., Shiue, I., Tedla, B. A., Thrift, A. G., Tonelli, M., Truelsen, T., Tsilimparis, N., Ukwaja, K. N., Uthman, O. A., Vasankari, T., Venketasubramanian, N., Vlassov, V. V., Vos, T., Westerman, R., Yan, L. L., Yano, Y., Yonemoto, N., Zaki, M. E. S., & Murray, C. J. L.
- Affiliations
- University of Washington (US)
- Jimma University, Jimma, Ethiopia
- University of Alabama at Birmingham (US)
- University of Oxford (GB)
- Universidad de Cartagena, Cartagena de Indias, Colombia
- South Australian Health and Medical Research Institute (AU)
- Farr Institute (GB)
- Harvard University (US)
- University of Canterbury (NZ)
- Madda Walabu University (ET)
- Independent Public Health Consultants, Addis Ababa, Ethiopia
- Universitat de València (ES)
- Auckland University of Technology (NZ)
- Pharmacology and Experimental Therapeutics, IBILI - Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Bielefeld University (DE)
- Mekelle University (ET)
- University of Massachusetts Boston (US)
- Eternal Hospital (IN)
- The University of Western Australia (AU)
- Heidelberg University (DE)
- Seoul National University (KR)
- Ministry of Health and Medical Education (IR)
- Southern University College (MY)
- Simmons University (US)
- National Cerebral and Cardiovascular Center (JP)
- Brown University (US)
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, QLD, Australia
- Universidade de São Paulo (BR)
- Digestive Disease Research Institute (IR)
- The University of Adelaide (AU)
- National Institutes of Health (US)
- Columbia University (US)
- SIU Medicine (US)
- The University of Sydney (AU)
- Ministry of Health and Social Welfare (TZ)
- Teikyo University (JP)
- University of British Columbia (CA)
- Contech School of Public Health, Lahore, Punjab, Pakistan
- Society for Health and Demographic Surveillance, Suri, India
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Marshall University (US)
- South African Medical Research Council (ZA)
- Southern Nations, Nationalities, and Peoples' Region (ET)
- Northumbria University (GB)
- James Cook University (AU)
- Monash Health (AU)
- University of Calgary (CA)
- University of Copenhagen (DK)
- Universität Hamburg (DE)
- Federal Teaching Hospital Abakaliki (NG)
- University of Warwick (GB)
- Urho Kaleva Kekkonen Institute (FI)
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
- National Research University Higher School of Economics, Moscow, Russia
- Federal Institute for Population Research (DE)
- Duke Kunshan University (CN)
- Northwestern University (US)
- National Center of Neurology and Psychiatry (JP)
- Mansoura University (EG)
- Corresponding author
- Murray, Christopher J. L.
- ORCID
- Forouzanfar, Mohammad H.
- Liu, Patrick
- Roth, Gregory A.
- Ng, Marie
- Marczak, Laurie
- Alexander, Lily
- Akinyemiju, Tomi F.
- Ali, Raghib
- Azzopardi, Peter
- Banerjee, Amitava
- Bärnighausen, Till
- Basu, Arindam
- Bennett, Derrick A.
- Biadgilign, Sibhatu
- Catalá-López, Ferrán
- Feigin, Valery L.
- Fischer, Florian
- Gona, Philimon
- Gupta, Rajeev
- Hankey, Graeme J.
- Jonas, Jost B.
- Judd, Suzanne E.
- Khang, Young-Ho
- Khosravi, Ardeshir
- Kim, Yun Jin
- Kimokoti, Ruth W.
- Kokubo, Yoshihiro
- Kolte, Dhaval
- Lotufo, Paulo A.
- Melaku, Yohannes Adama
- Mensah, George A.
- Misganaw, Awoke
- Mokdad, Ali H.
- Moran, Andrew E.
- Neal, Bruce
- Ohkubo, Takayoshi
- Pourmalek, Farshad
- Santos, Itamar S.
- Schutte, Aletta E.
- Sepanlou, Sadaf G.
- Shifa, Girma Temam
- Shiue, Ivy
- Tedla, Bemnet Amare
- Thrift, Amanda G.
- Tonelli, Marcello
- Tsilimparis, Nikolaos
- Ukwaja, Kingsley Nnanna
- Uthman, Olalekan A.
- Vasankari, Tommi
- Venketasubramanian, Narayanaswamy
- Vos, Theo
- Westerman, Ronny
- Yan, Lijing L.
- Yano, Yuichiro
- Yonemoto, Naohiro
- Zaki, Maysaa El Sayed
- Murray, Christopher J. L.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2017-01-10
- Volume
- 317
- Issue
- 2
- Pages
- 165
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2572331255
- Cited by
- 2,381
- References
- 56
- Citations by year
- 2026: 120 · 2025: 186 · 2024: 280 · 2023: 329 · 2022: 323 · 2021: 320 · 2020: 308 · 2019: 264 · 2018: 166 · 2017: 78 · 2016: 2
- FWCI
- 172.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- UWA Profiles and Research Repository (UWA) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
- UCL Discovery (University College London) (submittedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Northumbria Research Link (Northumbria University) (submittedVersion)
- PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Omron Healthcare
- National Institute for Health and Care Research (CL-2010-09-002)
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- hypertension, systolic blood pressure, global burden of disease, ischemic heart disease, ischemic stroke, hemorrhagic stroke, disability-adjusted life years, cause-specific mortality, cardiovascular disease, health loss, age and sex differences, spatiotemporal trends, cardiovascular risk factors, 1990-2015 trends
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Pressure, Cause of Death, Female, Health Surveys, Humans, Hypertension, Male, Middle Aged, Monte Carlo Method, Systole, Global Health, Prevalence, Normal Distribution, Myocardial Ischemia, Age Distribution, Sex Distribution, Risk Assessment, Quality-Adjusted Life Years, Intracranial Hemorrhages, Stroke, Uncertainty, Renal Insufficiency, Chronic
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