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Greatest BP levels shifted from high- to low-income countries
Data collected in the last 4 decades worldwide show a shift in elevated BP from high-income to low- and middle-income countries in South Asia and sub-Saharan Africa while remaining consistently high in Central and Eastern Europe, according to the NCD Risk Factor Collaboration.
“This study provides the most complete picture of trends in adult [BP] for all countries in the world with the longest observational period of any global [BP] study to our knowledge and includes trends in mean diastolic BP and prevalence of raised BP, which were not included in previous studies and are of clinical, public health and health systems significance,” the researchers wrote in a study published in The Lancet.
A total of 1,479 national, subnational or community population-based studies that measured BP in 19.1 million individuals aged 18 years or older were pooled by researchers for the study. Trends for the mean systolic and diastolic BP and the prevalence of raised BP for 200 countries between 1975 and 2015 were estimated using a Bayesian hierarchical model. The researchers also calculated contributions of changes in prevalence vs. population growth and aging to an increase in number of adults with raised BP.
Age-standardized BP
In 2015, the global age-standardized mean systolic BP in men was 127 mm Hg (95% CI, 125.7-128.3) and 122.3 mm Hg (95% CI, 121-123.6) in women, according to the researchers.
Age-standardized mean diastolic BP for men was 78.7 mm Hg (95% CI, 77.9-79.5) and 76.7 mm Hg (95% CI, 75.9-77.6) for women, they wrote.
In men, global age-standardized prevalence of raised BP was 24.1% (95% CI, 21.4-27.1) for men and 20.1% (95% CI, 17.8-22.5) in women in 2015.
From 1975 to 2015, there was a substantial decrease of mean systolic and diastolic BP in high-income Western and Asia Pacific countries. These countries went from having among the highest levels of BP in 1975 to having the among the lowest in 2015.
There was also a decrease in the mean BP among women in Central and Eastern Europe, Latin America, the Caribbean, Asia, the Middle East and North Africa. However, according the researchers, there was more uncertainty about the trend in these regions than in high-income regions.
The highest levels of BP in 2015 were found in Central and Eastern Europe, sub-Saharan Africa, and South Asia, the researchers wrote.
Worldwide rise
Population growth, aging and decrease due to declining age-specific prevalence all played a role in the global increase in adults with elevated BP. By 2015, the number of adults with raised BP had risen to 1.13 billion from the 594 million in 1975, according to the researchers.
“The number of people with raised BP has risen worldwide, with the increase happening mainly in low-income and middle-income countries,” the researchers wrote. “Population-based interventions throughout the life-course and pharmacological treatment for people with high absolute risk of people with substantially raised BP should be a part of any effort to address the global burden of non-communicable diseases, especially in the poorest countries.” – by Dave Quaile
Disclosure: The study was funded by Wellcome Trust. Several researchers report financial ties with Amgen, AstraZeneca, GlaxoSmithKline and Iterim.