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

Zhou, Bin and Bentham, James and Di Cesare, Mariachiara and Danaei, Goodarz and Hajifathalian, Kaveh and Taddei, Cristina and Carrillo-Larco, Rodrigo M. and Djalalinia, Shirin and Khatibzadeh, Shahab and Lugero, Charles and Peykari, Niloofar and Zhang, Wan Zhu and Bilano, Ver and Stevens, Gretchen A. and Cowan, Melanie J. and Riley, Leanne M. and Zhengming, Chen and Hambleton, Ian and Jackson, Rod T. and Kengne, Andre Pascal and Khang, Young-Ho and Laxmaiah, Avula and Liu, Jing and Malekzadeh, Reza and Neuhauser, Hannelore K. and Soric, Maroje and Starc, Gregor and Sundstrom, Johan and Woodward, Mark and Ezzati, Majid and NCD Risk Factor Collaboration, (NCD-RisC) (2018) 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. International Journal of Epidemiology, 47 (3). 872-883i. ISSN 0300-5771

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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 1,018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean SBP, mean 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 2005-2016, at the same level of population mean SBP and DBP, men and women in south Asia and in central Asia, 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.

Item Type: Article
Research Areas: A. > School of Science and Technology > Natural Sciences
Item ID: 23488
Notes on copyright: Final accepted version: This is a pre-copyedited, author-produced version of an article accepted for publication in International Journal of Epidemiology following peer review. The version of record NCD Risk Factor Collaboration (NCD-RisC); 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, International Journal of Epidemiology, Volume 47, Issue 3, 1 June 2018, Pages 872–883i, is available online at: https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyy016/4944405 and https://doi.org/10.1093/ije/dyy016
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Depositing User: Mariachiara Di Cesare
Date Deposited: 05 Feb 2018 10:57
Last Modified: 15 Sep 2018 04:49
URI: http://eprints.mdx.ac.uk/id/eprint/23488

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