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

NCD Risk Factor Collaboration (NCD-RisC)

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Abstract

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 (probittransformed) 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 highincome 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.

Original languageEnglish
Pages (from-to)872-883i
JournalInternational Journal of Epidemiology
Volume47
Issue number3
DOIs
Publication statusPublished - Jun 2018

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Blood Pressure
Population
Age Groups
Central Asia
Hypertension
Northern Africa
Eastern Africa
Middle East

All Science Journal Classification (ASJC) codes

  • Epidemiology

Cite this

@article{e44e53cfb2c4461482a0f4464bb8ccc2,
title = "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",
abstract = "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 (probittransformed) 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 highincome 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.",
author = "{NCD Risk Factor Collaboration (NCD-RisC)} and Majid Ezzati and Bin Zhou and James Bentham and {Di Cesare}, Mariachiara and Honor Bixby and Goodarz Danaei and Kaveh Hajifathalian and Cristina Taddei and Carrillo-Larco, {Rodrigo M.} and Shirin Djalalinia and Shahab Khatibzadeh and Charles Lugero and Niloofar Peykari and Zhang, {Wan Zhu} and James Bennett and Ver Bilano and Stevens, {Gretchen A.} and Cowan, {Melanie J.} and Riley, {Leanne M.} and Zhengming Chen and Hambleton, {Ian R.} and Jackson, {Rod T.} and Kengne, {Andre Pascal} and Khang, {Young Ho} and Avula Laxmaiah and Jing Liu and Reza Malekzadeh and Neuhauser, {Hannelore K.} and Maroje Sorić and Gregor Starc and Johan Sundstr{\"o}m and Mark Woodward and Leandra Abarca-G{\'o}mez and Abdeen, {Ziad A.} and Abu-Rmeileh, {Niveen M.} and Benjamin Acosta-Cazares and Adams, {Robert J.} and Wichai Aekplakorn and Kaosar Afsana and Aguilar-Salinas, {Carlos A.} and Charles Agyemang and Ahmad, {Noor Ani} and Alireza Ahmadvand and Wolfgang Ahrens and Kamel Ajlouni and Nazgul Akhtaeva and Rajaa Al-Raddadi and Ali, {Mohamed M.} and Osman Ali and Ala'a Alkerwi",
year = "2018",
month = "6",
doi = "10.1093/ije/dyy016",
language = "English",
volume = "47",
pages = "872--883i",
journal = "International Journal of Epidemiology",
issn = "0300-5771",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure

T2 - A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

AU - NCD Risk Factor Collaboration (NCD-RisC)

AU - Ezzati, Majid

AU - Zhou, Bin

AU - Bentham, James

AU - Di Cesare, Mariachiara

AU - Bixby, Honor

AU - Danaei, Goodarz

AU - Hajifathalian, Kaveh

AU - Taddei, Cristina

AU - Carrillo-Larco, Rodrigo M.

AU - Djalalinia, Shirin

AU - Khatibzadeh, Shahab

AU - Lugero, Charles

AU - Peykari, Niloofar

AU - Zhang, Wan Zhu

AU - Bennett, James

AU - Bilano, Ver

AU - Stevens, Gretchen A.

AU - Cowan, Melanie J.

AU - Riley, Leanne M.

AU - Chen, Zhengming

AU - Hambleton, Ian R.

AU - Jackson, Rod T.

AU - Kengne, Andre Pascal

AU - Khang, Young Ho

AU - Laxmaiah, Avula

AU - Liu, Jing

AU - Malekzadeh, Reza

AU - Neuhauser, Hannelore K.

AU - Sorić, Maroje

AU - Starc, Gregor

AU - Sundström, Johan

AU - Woodward, Mark

AU - Abarca-Gómez, Leandra

AU - Abdeen, Ziad A.

AU - Abu-Rmeileh, Niveen M.

AU - Acosta-Cazares, Benjamin

AU - Adams, Robert J.

AU - Aekplakorn, Wichai

AU - Afsana, Kaosar

AU - Aguilar-Salinas, Carlos A.

AU - Agyemang, Charles

AU - Ahmad, Noor Ani

AU - Ahmadvand, Alireza

AU - Ahrens, Wolfgang

AU - Ajlouni, Kamel

AU - Akhtaeva, Nazgul

AU - Al-Raddadi, Rajaa

AU - Ali, Mohamed M.

AU - Ali, Osman

AU - Alkerwi, Ala'a

PY - 2018/6

Y1 - 2018/6

N2 - 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 (probittransformed) 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 highincome 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.

AB - 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 (probittransformed) 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 highincome 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.

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U2 - 10.1093/ije/dyy016

DO - 10.1093/ije/dyy016

M3 - Article

C2 - 29579276

AN - SCOPUS:85050702158

VL - 47

SP - 872-883i

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

IS - 3

ER -