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Elevated systolic BP, related deaths rose worldwide over 25 years; burden in US high
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Between 1990 and 2015, the incidence of elevated systolic BP rose worldwide, as did the incidence of death and disability related to high systolic BP, according to findings from the Global Burden of Diseases, Injuries and Risk Factors Study 2015, published in JAMA.
The researchers estimated the association of systolic BP 110 mm Hg to 115 mm Hg and 140 mm Hg with the burden of causes of death and disability by age and sex for populations in 195 countries and territories between 1990 and 2015.
They derived BP data from 844 studies covering 8.69 million participants in 154 countries conducted between 1980 and 2015.
The outcomes of interest were mean systolic BP level, cause-specific deaths and health burden related to systolic BP 110 mm Hg to 115 mm Hg and 140 mm Hg categorized by age, sex, country and year.
Global burden rising
Mohammed H. Foroufanzar, PhD, and colleagues found that between 1990 and 2015, the rate of systolic BP 110 mm Hg to 115 mm Hg rose from 73,119 per 100,000 people (95% uncertainty interval [UI], 67,949-78,241) to 81,373 per 100,000 people (95% UI, 76,814-85,770).
Foroufanzar, from the Institute for Health Metrics and Evaluation, University of Washington, Seattle, and colleagues also found that the rate of systolic BP 140 mm Hg increased from 17,307 per 100,000 people (95% UI, 17,117-17,492) in 1990 to 20,526 per 100,000 people (95% UI, 20,283-20,746) in 2015.
They estimated the annual death rate per 100,000 people associated with systolic BP 110 mm Hg to 115 mm Hg rose from 135.6 (95% UI, 122.4-148.1) in 1990 to 145.2 (95% UI, 130.3-159.9) in 2015, and annual death rate per 100,000 people associated with systolic BP 140 mm Hg rose from 97.9 (95% UI, 87.5-108.1) in 1990 to 106.3 (95% UI, 94.6-118.1) in 2015.
Loss of disability-adjusted life-years (DALYs) related to systolic BP 110 mm Hg to 115 mm Hg rose from 148 million (95% UI, 134-162 million) in 1990 to 211 million (95% UI, 193-231 million) in 2015, and loss of DALYs related to systolic BP 140 mm Hg increased from 5.2 million (95% UI, 4.6-5.7 million) in 1990 to 7.8 million (95% UI, 7-8.7 million), according to the researchers.
The most common cause of death related to systolic BP was ischemic heart disease (4.9 million), followed by hemorrhagic stroke (2 million) and ischemic stroke (1.5 million), Foroufanzar and colleagues wrote.
In 2015, five countries accounted for more than half of global DALYs tied to systolic BP 110 mm Hg to 115 mm Hg: China, India, Indonesia, Russia and the United States.
Prevention is key
In a related editorial, Mark D. Huffman, MD, MPH, and Donald M. Lloyd-Jones, MD, ScM, both from Northwestern University Feinberg School of Medicine, wrote that “both broad population-level and high-risk clinical strategies are needed to reduce the burden of [CV] and other diseases related to elevated [systolic BP]. ... Preventing the onset of clinical hypertension (ie, primary prevention) and blunting or abolishing the rise in [systolic BP] from 110 mm Hg through prehypertensive levels to 140 mm Hg or higher is imperative to prevent premature death and disability from [CVD].”
Huffman and Lloyd-Jones wrote the findings “strengthen the case to lower the risk for [CVD] in those with [systolic BP 140 mm Hg] by all effective means available, including improving uptake of healthy diets, minimizing weight gain or promoting weight loss in overweight or obese individuals, and promoting uptake and adherence to effective [BP]-lowering drugs as well as management of related [CV] risk.” – by Erik Swain
Disclosure : Foroufanzar, Huffman and Lloyd-Jones report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
Perspective
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Randall Zusman, MD
One of the most striking things noted in this article is the increasing incidence of hypertension on a worldwide basis. Despite our knowing for approximately 50 years that hypertension is a major risk factor for CV events — MI, stroke, renal disease, peripheral arterial disease and congestive HF — the incidence of elevated BP values continues to grow. This points to a failure of broad-based health programming to make not only individuals and communities, but also government institutions address the consequences of the often health-impairing lifestyles which are counterproductive to the long-term health of the population. Excessive dietary salt/sugar intake, obesity, smoking, and a sedentary lifestyle are only a few of the causes of the higher incidence of elevated BP values.
I can't say I was surprised at the findings, but I was struck by the detail of the analysis pointing to a worldwide increase in the increasingly hypertensive population.
The implications for clinical practice are that despite having so many effective antihypertensive therapies, including many that are, essentially, side effect-free, there is an ongoing need to find a way to lower the BP of persons on a worldwide basis. Hundreds of millions of persons need to be evaluated and potentially treated for their BP abnormalities.
In view of the worldwide need to treat hypertension, as well as other risk factors including hypercholesterolemia, diabetes, obesity, tobacco abuse and sedentary lifestyles, we need to find more effective and perhaps less expensive strategies. One such strategy is the use of the relaxation response, which I have studied for the treatment of hypertension, and is independent of drug therapy. In developing nations where the cost of drugs may be prohibitive, but where, paradoxically, access to the internet is available, online-based relaxation response strategies may be an effective, productive and health-promoting strategy.
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