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Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants
Imperial Coll London, London W2 1PG, England.
Imperial Coll London, London W2 1PG, England;Univ Kent, Canterbury, Kent, England.
Middlesex Univ, London, England.
Imperial Coll London, London W2 1PG, England.
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 3, p. 872-883iArticle in journal (Refereed) Published
Abstract [en]

Background

Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.

Methods

We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.

Results

In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.

Conclusions

Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2018. Vol. 47, no 3, p. 872-883i
Keywords [en]
Blood pressure, hypertension, population health, global health, non-communicable disease
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-361286DOI: 10.1093/ije/dyy016ISI: 000438342200023PubMedID: 29579276OAI: oai:DiVA.org:uu-361286DiVA, id: diva2:1251405
Funder
Wellcome trust, 101506/Z/13/Z
Note

NCD Risk Factor Collaboration (NCD-RisC) Members are listed at the end of the paper

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-11-15Bibliographically approved

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