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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.”
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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“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.”
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BackgroundThe Story of the Silent Killer
Kalehoff, J. P., & Oparil, S. (2020) · Current Hypertension Reports · doi:10.1007/s11906-020-01077-7 · Cited by 89
Guía ESC 2021 sobre la prevención de la enfermedad cardiovascular en la práctica clínica
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Bénétos, A., Biffi, A., Boavida, J. M., Capodanno, D., et al. (2022) · Revista Española de Cardiología · doi:10.1016/j.recesp.2021.10.016 · Cited by 89
Nitric oxide deficiency is a primary driver of hypertension
Bryan, N. S. (2022) · Biochemical Pharmacology · doi:10.1016/j.bcp.2022.115325 · Cited by 77
Basu, S., Sussman, J. B., Rigdon, J., Steimle, L., Denton, B. T., & Hayward, R. A. (2017) · PLOS Medicine · doi:10.1371/journal.pmed.1002410 · Cited by 77
Muli, S., Meisinger, C., Heier, M., Thorand, B., Peters, A., & Amann, U. (2020) · BMC Public Health · doi:10.1186/s12889-020-09165-8 · Cited by 77
Resistant Hypertension in People With CKD: A Review
Fay, K., & Cohen, D. L. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2020.04.017 · Cited by 80
Campbell, N. R. C., Whelton, P. K., Orías, M., Wainford, R. D., Cappuccio, F. P., Ide, N., Neal, B. C., Cohn, J., Cobb, L. K., Webster, J. L., et al. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-022-00690-0 · Cited by 81
Self-citationCentral nervous system neuroplasticity and the sensitization of hypertension
Johnson, A. K., & Xue, B. (2018) · Nature Reviews Nephrology · doi:10.1038/s41581-018-0068-5 · Cited by 80
Taylor, K. A., Wiles, J. D., Coleman, D. A., Leeson, P., Sharma, R., & O’Driscoll, J. M. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001922 · Cited by 81
“Recent evidence suggests that the prevalence of HTN is increasing [2], which places a substantial economic burden on public health services.”
BackgroundIsometric Exercise Training and Arterial Hypertension: An Updated Review
Edwards, J. J., Coleman, D. A., Ritti‐Dias, R. M., Farah, B. Q., Stensel, D. J., Lucas, S. J. E., Millar, P. J., Gordon, B. D., Cornelissen, V., Smart, N. A., et al. (2024) · Sports Medicine · doi:10.1007/s40279-024-02036-x · Cited by 98
“HTN is estimated to affect 1.13 billion people globally, and due to its asymptomatic nature, this figure may be an underestimate [13, 14].”
BackgroundInfluentialStatistics, Adjusted Statistics, and Maladjusted Statistics
Kaufman, J. S. (2017) · American Journal of Law & Medicine · doi:10.1177/0098858817723659 · Cited by 75
Kibria, G. M. A. (2019) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2019.100850 · Cited by 76
Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia
Shukuri, A., Tewelde, T., & Shaweno, T. (2019) · Integrated Blood Pressure Control · doi:10.2147/ibpc.s212821 · Cited by 74
“For example, a population-based cross-sectional study conducted in Miyun district of Beijing Chinese showed that the prevalence of hypertension in the community elderly was 53%.(28) Another study conducted in Sao Paulo, Brazil among the elderly showed the prevalence of hypertension to be 46.”
BackgroundIncident Cardiovascular Disease Among Adults With Blood Pressure <140/90 mm Hg
Tajeu, G. S., Booth, J. N., Colantonio, L. D., Gottesman, R. F., Howard, G., Lackland, D. T., O'Brien, E. C., Oparil, S., Ravenell, J. E., Safford, M. M., et al. (2017) · Circulation · doi:10.1161/circulationaha.117.027362 · Cited by 74
Sympathetic Nervous System, Sleep, and Hypertension
Seravalle, G., Mancia, G., & Grassi, G. M. (2018) · Current Hypertension Reports · doi:10.1007/s11906-018-0874-y · Cited by 77
São Paulo call to action for the prevention and control of high blood pressure: 2020
Campbell, N. R. C., Schutte, A. E., Varghese, C. V., Ordunez, P., Zhang, X., Khan, T., Sharman, J. E., Whelton, P. K., Parati, G., Weber, M. A., et al. (2019) · The Journal of Clinical Hypertension · doi:10.1111/jch.13741 · Cited by 72
Self-citationBo, Y., Kwok, K. O., Chung, V. C., Yu, C., Tsoi, K. K., Wong, S. Y. S., & Lee, E. K. P. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002522 · Cited by 73
“0000000000002522 H ypertension is the most common chronic condition, contributing to physical complications and substantial burden to healthcare systems [1].”
BackgroundLong-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension
Robinson, C., Hussain, J., Jeyakumar, N., Smith, G., Birken, C. S., Dart, A. B., Dionne, J. M., Garg, A., Kandasamy, S., Karam, S., et al. (2024) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2024.1543 · Cited by 79
Lü, L., Sun, X., Chen, C., Qin, Y., & Guo, X. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.01161 · Cited by 72
“REVIEW published: 14 November 2018 doi: 10.3389/fphar.2018.01161 Edited by: Aiping Lu, Hong Kong Baptist University, Hong Kong Reviewed by: Wei Song, Peking Union Medical College Hospital (CAMS), China Haolong Liu, Peking University Health Science Center, China *Correspondence: Xiaomei Guo xiaomguo@yeah.net Specialty…”
BackgroundInfluentialPrevalence, Awareness, Treatment, and Control of Hypertension in Korea
Kang, S., Kim, S., Cho, J. H., Yoon, C., Hwang, S.-S., Lee, H., Youn, T., Chae, I., & Kim, C. (2019) · Scientific Reports · doi:10.1038/s41598-019-46965-4 · Cited by 72
Hypertension and diabetes mellitus: highlights of a complex relationship
Yildiz, M., Esenboğa, K., & Oktay, A. A. (2020) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000748 · Cited by 75
“deaths in 2017 to high systolic blood pressure (SBP) ( 140 mmHg) and diabetes mellitus, respectively [3,4].”
BackgroundLi, J., Somers, V. K., Gao, X., Chen, Z., Ju, J., Lin, Q., Mohamed, E. A., Karim, S., Xu, H. F., & Zhang, L. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.37554 · Cited by 73
McLean, R. M., & Wang, N. X. (2021) · Advances in food and nutrition research · doi:10.1016/bs.afnr.2021.02.013 · Cited by 88
Qu, Y., Lv, Y., Ji, S., Ding, L., Zhao, F., Zhu, Y. B., Zhang, W., Hu, X., Lu, Y., Li, Y., et al. (2022) · Environmental Pollution · doi:10.1016/j.envpol.2022.118864 · Cited by 71
Okubadejo, N. U., Ozoh, O. B., Ojo, O. O., Akinkugbe, A., Odeniyi, I. A., Adegoke, O., Bello, B. T., & Agabi, O. P. (2019) · Clinical Hypertension · doi:10.1186/s40885-019-0112-1 · Cited by 71
Islam, J. Y., Zaman, M. M., Haq, S. A., Ahmed, S., & Quadir, Z. A. (2018) · Journal of Human Hypertension · doi:10.1038/s41371-018-0087-5 · Cited by 70
Tsioufis, K. P., Kreutz, R. H., Sykara, G. D., van Vugt, J., & Hassan, T. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002381 · Cited by 72
Impact of the National Essential Public Health Services Policy on Hypertension Control in China
Zhang, D. “., Pan, X., Li, S., Liang, D., Hou, Z., Li, Y., & Shi, L. (2017) · American Journal of Hypertension · doi:10.1093/ajh/hpx139 · Cited by 69
Impact of Conventional Stroke Risk Factors on Stroke in Women
Madsen, T. E., Howard, V. J., Jiménez, M. C., Rexrode, K. M., Acelajado, M. C., Kleindorfer, D., & Chaturvedi, S. (2018) · Stroke · doi:10.1161/strokeaha.117.018418 · Cited by 72
“In addition, the prevalence of hypertension may be increasing over time, with trends varying by age, sex, race/ethnicity, and geographic region.(3,8) Moreover, among women, consideration of pregnancy related hypertension disorders, which may have longlasting effects on a woman’s cardiovascular health, should be consid…”
BackgroundPugliese, N. R., Mazzola, M., Fabiani, I., Gargani, L., Biase, N. D., Pedrinelli, R., Natali, A., & Dini, F. L. (2020) · European Journal of Heart Failure · doi:10.1002/ejhf.1739 · Cited by 69
Advances in Non-Invasive Blood Pressure Measurement Techniques
Panula, T., Sirkiä, J., Wong, D., & Kaisti, M. (2022) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2022.3141877 · Cited by 70
“[37] At the same time, hypertension is the most common preventable risk factor”
BackgroundBlood pressure control: a challenge to global health systems
Chow, C. K., & Gupta, R. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31293-0 · Cited by 68
Self-citationEffect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension
Ghiasi, S. S., Jalalyazdi, M., Ramezani, J., Izadi‐Moud, A., Madani-Sani, F., & Shahlaei, S. (2019) · Journal of Advanced Pharmaceutical Technology amp Research · doi:10.4103/japtr.japtr_402_18 · Cited by 67
Smartphone apps for improving medication adherence in hypertension: patients’ perspectives
Morrissey, E. C., Casey, M., Glynn, L. G., Walsh, J. C., & Molloy, G. J. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s145647 · Cited by 68
“Therefore, this condition represents a global health challenge.(3) Blood pressure (BP) control through pharmacological treatment has led to substantial benefits in the prevention of morbidity and mortality from cardiovascular disease.”
Treatment of Hypertension in Patients with Asthma
Christiansen, S. C., & Zuraw, B. L. (2019) · New England Journal of Medicine · doi:10.1056/nejmra1800345 · Cited by 71
Update of the position paper on arterial hypertension and erectile dysfunction
Viigimaa, M., Vlachopoulos, C. V., Doumas, M. N., Wolf, J., Imprialos, K. P., Terentes-Printzios, D. G., Ioakeimidis, N., Kotsar, A., Kiitam, U., Stavropoulos, K., et al. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002382 · Cited by 69
Metadata
- 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
- 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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