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Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

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Forouzanfar, Mohammad H., Liu, Patrick, Roth, Gregory A., Ng, Marie, Biryukov, Stan, Marczak, Laurie, Alexander, Lily, Estep, Kara, Hassen Abate, Kalkidan, Akinyemiju, Tomi F., Ali, Raghib, Alvis-Guzman, Nelson, Azzopardi, Peter, Banerjee, Amitava, Bärnighausen, Till, Basu, Arindam, Bekele, Tolesa, Bennett, Derrick A., Biadgilign, Sibhatu, Catalá-López, Ferrán, Feigin, Valery L., Fernandes, Joao C., Fischer, Florian, Gebru, Alemseged Aregay, 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, Lopez, Alan, Lotufo, Paulo A., Malekzadeh, Reza, Melaku, Yohannes Adama, Mensah, George A., Misganaw, Awoke, Mokdad, Ali H., Moran, Andrew E., Nawaz, Haseeb, Neal, Bruce, Ngalesoni, Frida Namnyak, Ohkubo, Takayoshi, Pourmalek, Farshad, Rafay, Anwar, Rai, Rajesh Kumar, Rojas-Rueda, David, Sampson, Uchechukwu K., Santos, Itamar S., Sawhney, Monika, Schutte, Aletta E., Sepanlou, Sadaf G., Shifa, Girma Temam, Shiue, Ivy, Tedla, Bemnet Amare, Thrift, Amanda G., Tonelli, Marcello, Truelsen, Thomas, Tsilimparis, Nikolaos, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A., Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Vos, Theo, Westerman, Ronny, Yan, Lijing L., Yano, Yuichiro, Yonemoto, Naohiro, Zaki, Maysaa El Sayed, Murray, Christopher J. L.·2017·JAMA

DOI 10.1001/jama.2016.19043

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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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Restaurant interventions for salt reduction in China: protocol for a randomised controlled trial
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Compound danshen dripping pills affect the pharmacokinetics of azisartan by regulating the expression of cytochrome P450 2B1, 2C6, and 2C11 in rats
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Ibandronate promotes autophagy by inhibiting Rac1–mTOR signaling pathway in vitro and in vivo
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Meta‐analysis on the association between the frequency of tooth brushing and hypertension risk
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Correlation between Blunted Nocturnal Decrease in Diastolic Blood Pressure and Oxidative Stress: An Observational Study
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Plethysmographic Waveform Features and Hemodynamic Features for Camera-Based Blood Pressure Estimation
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May Measurement Month 2018: an analysis of blood pressure screening results from Ghana
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“Hypertension is a leading global health risk and important global health challenge due to its high prevalence and resultingmorbidities.(1,2) It is estimated to result in about 11 million deaths globally.”
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Pharmacological characterization of MT-1207, a novel multitarget antihypertensive agent
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Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study
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Dissecting the Regulation of Arachidonic Acid Metabolites by Uncaria rhynchophylla (Miq). Miq. in Spontaneously Hypertensive Rats and the Predictive Target sEH in the Anti-Hypertensive Effect Based on Metabolomics and Molecular Docking
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Of Mouse and Man: Cross-Species Characterization of Hypertensive Cardiac Remodeling
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Minimization of Power Loss in Distribution System by Tap Changing Transformer using PSO Algorithm
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Generational differences in longitudinal blood pressure trajectories by geographic region during socioeconomic transitions in China
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A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative
Krishna, A., Pathni, A. K., Sharma, B., Shivashankar, R., Shrivastava, S., & Hering, D. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13944 · Cited by 10
“A semi-structured interview was based on the key components of the IHCI project including implementation of (1) the state treatment hypertension protocol (ie, stepped-care drug therapy tailored every 30 days if BP is ≥140 or ≥90 mm Hg prescribing once daily Amlodipine 5 mg, then increasing to Amlodipine 10 mg, followe…”
BackgroundMethodInfluential
Results of a project to calibrate mercury sphygmomanometer blood pressure-measuring devices in Egypt
Ghareeb, S., Youssef, G., Ghareeb, H. S., El-Mageed, H. A., Mesalm, M. H., Talaat, R., Eltawil, A. A., Hasan, D. M., & Ibrahim, M. M. (2020) · Journal of Human Hypertension · doi:10.1038/s41371-020-00424-0 · Cited by 10
N-Terminal Pro-B-Type Natriuretic Peptide and Longitudinal Risk of Hypertension
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Validation of Omron Wearable Blood Pressure Monitor HeartGuideTM in Free-Living Environments
Liang, Z., & Martell, M. A. C. (2021) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-030-70569-5_22 · Cited by 9
Prevalence and factors associated with treatment and control of hypertension among adults with hypertension in Myanmar
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Kidney ion handling genes and their interaction in blood pressure control
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The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review
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Renin-angiotensin inhibitors reduce thrombotic complications in Essential Thrombocythemia and Polycythemia Vera patients with arterial hypertension
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“Elevated blood pressure levels can result in detrimental cardiovascular implications, amplifying the risk of mortality [30, 31].”
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Association between short-term daily temperature variability and blood pressure in the Chinese population: From the China hypertension survey
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Investigating the association between nitrate dosing and nitrite generation by the human oral microbiota in continuous culture
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Association of Blood Pressure With Brain Ages: A Cohort Study of Gray and White Matter Aging Discrepancy in Mid-to-Older Adults From UK Biobank
Du, J., Pan, Y., Jiang, J.-Y., Liu, Y., Lam, B. C. P., Schutte, A., Tsang, I., Sachdev, P. S., & Wen, W. (2024) · HYPERTENSION · doi:10.1161/hypertensionaha.123.22176 · Cited by 8
“33 Epidemiological studies also demonstrated that SBP was a more related antihypertensive therapeutic target than DBP. 34 The nonlinear relationship (especially the U shape and J shape) has been widely observed between the diastolic BP and increased volume of white matter intensity, 35 dementia, 36…”
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mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users
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“Arterial hypertension is one of the most important risk factors for cardiovascular disease, affecting over 1 billion people worldwide [2].”
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Polygenic Interactions With Environmental Exposures in Blood Pressure Regulation: The HUNT Study
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The blood pressure-lowering property of subcutaneous semaglutide: a systematic review, meta-analysis, and meta-regression
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“Hypertension accounts for a significant burden of cardio - vascular diseases [1, 2].”
Burden trends and future predictions for hypertensive heart disease attributable to non-optimal temperatures in the older adults amidst climate change, 1990–2021
Xu, C., Nie, X., Xu, R. P., Han, G., & Wang, D. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1525357 · Cited by 9
Aging and sex differences in salt sensitivity of blood pressure
Demirci, M., Afolabi, J., & Kirabo, A. (2025) · Clinical Science · doi:10.1042/cs20240788 · Cited by 11
Early onset of hypertension and increased relative risks of chronic kidney disease and mortality: two population-based cohort studies in United Kingdom and Hong Kong
Liu, K. S., Wang, B., Mak, I. L., Choi, E. P. H., Lam, C. L. K., & Wan, E. Y. F. (2025) · Hypertension Research · doi:10.1038/s41440-025-02188-x · Cited by 9
“As the leading risk factor for chronic comorbidities and mortality, high blood pressure was associated with 7.8 million all-cause deaths, accounting for 14.0% of all deaths, in 2015 [3].”
Influential
Transtheoretical model on the self-care behavior of hypertension patients: a systematic review
Hasriani, H., Sjattar, E. L., & Arafat, R. (2021) · Journal of Health Research · doi:10.1108/jhr-01-2021-0053 · Cited by 10
Cost Effectiveness of the First‐in‐Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting
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Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 2019
Abrahams‐Gessel, S., Gómez-Olivé, F. X., Tollman, S. M., Wade, A. N., du Toit, J., Ferro, E. G., Kabudula, C. W., & Gaziano, T. A. (2023) · American Journal of Hypertension · doi:10.1093/ajh/hpad018 · Cited by 9

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
DOI: 10.1001/jama.2016.19043
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
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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Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

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