Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015

Mohammad H. Forouzanfar, Patrick Liu, Gregory A. Roth, Marie Ng, Stan Biryukov, Laurie Marczak, Lily Alexander, Kara Estep, Kalkidan Hassen Abate, Tomi F. Akinyemiju, Raghib Ali, Nelson Alvis-Guzman, Peter Azzopardi, Amitava Banerjee, Till Bärnighausen, Arindam Basu, Tolesa Bekele, Derrick A. Bennett, Sibhatu Biadgilign, Ferrán Catalá-LópezValery L. Feigin, Joao C. Fernandes, Florian Fischer, Alemseged Aregay Gebru, Philimon Gona, Rajeev Gupta, Graeme J. Hankey, Jost B. Jonas, Suzanne E. Judd, Young Ho Khang, Ardeshir Khosravi, Yun Jin Kim, Ruth W. Kimokoti, Yoshihiro Kokubo, Dhaval Kolte, Alan Lopez, Paulo A. Lotufo, Reza Malekzadeh, Yohannes Adama Melaku, George A. Mensah, Awoke Misganaw, Ali H. Mokdad, Andrew E. Moran, Haseeb Nawaz, Bruce Neal, Frida Namnyak Ngalesoni, Takayoshi Ohkubo, Farshad Pourmalek, Anwar Rafay, Rajesh Kumar Rai, David Rojas-Rueda, Uchechukwu K. Sampson, Itamar S. Santos, Monika Sawhney, Aletta E. Schutte, Sadaf G. Sepanlou, Girma Temam Shifa, Ivy Shiue, Bemnet Amare Tedla, Amanda G. Thrift, Marcello Tonelli, Thomas Truelsen, Nikolaos Tsilimparis, Kingsley Nnanna Ukwaja, Olalekan A. Uthman, Tommi Vasankari, Narayanaswamy Venketasubramanian, Vasiliy Victorovich Vlassov, Theo Vos, Ronny Westerman, Lijing L. Yan, Yuichiro Yano, Naohiro Yonemoto, Maysaa El Sayed Zaki, Christopher J.L. Murray

Research output: Contribution to journalArticle

Abstract

IMPORTANCE Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE To estimate the association between SBP of at least 110 to 115mmHg and SBP of 140mmHg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES Mean SBP level, cause-specific deaths, and health burden related to SBP (≤110-115mmHg and also≤140mmHg) by age, sex, country, and year. RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115mmHg increased from 73 119 (95%uncertainty interval [UI], 67 949-78 241) to 81 373 (95%UI, 76 814-85 770) per 100000, and SBP of 140mmHg or higher increased from 17 307 (95%UI, 17 117-17 492) to 20526 (95%UI, 20283-20746) per 100000. The estimated annual death rate per 100000associated with SBP of at least 110 to 115mmHg increased from 135.6 (95%UI, 122.4-148.1) to 145.2 (95%UI 130.3-159.9) and the rate for SBP of 140mmHg or higher increased from 97.9 (95%UI, 87.5-108.1) to 106.3 (95%UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115mmHg increased from 148 million (95%UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140mmHg or higher, the loss increased from 95.9 million (95%UI, 87.0-104.9 million) to 143.0million (95%UI, 130.2-157.0million). The largest numbers of SBP-related deathswere caused by ischemic heart disease (4.9 million [95%UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0million [95%UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95%UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the globalDALYs related to SBP of at least 110 to 115mmHg. CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≤110-115 and≤140mmHg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115mmHg and 874 million adults had SBP of 140mmHg or higher.

Original languageEnglish (US)
Pages (from-to)165-182
Number of pages18
JournalJAMA - Journal of the American Medical Association
Volume317
Issue number2
DOIs
StatePublished - Jan 10 2017

Fingerprint

Uncertainty
Blood Pressure
Hypertension
Stroke
Quality-Adjusted Life Years
Myocardial Ischemia
Cause of Death
Indonesia
Russia
Health
India
China

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L., ... Murray, C. J. L. (2017). Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015. JAMA - Journal of the American Medical Association, 317(2), 165-182. https://doi.org/10.1001/jama.2016.19043

Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015. / Forouzanfar, Mohammad H.; Liu, Patrick; Roth, Gregory A.; Ng, Marie; Biryukov, Stan; Marczak, Laurie; Alexander, Lily; Estep, Kara; Abate, Kalkidan Hassen; Akinyemiju, Tomi F.; Ali, Raghib; Alvis-Guzman, Nelson; Azzopardi, Peter; Banerjee, Amitava; Bärnighausen, Till; Basu, Arindam; Bekele, Tolesa; Bennett, Derrick A.; Biadgilign, Sibhatu; Catalá-López, Ferrán; Feigin, Valery L.; Fernandes, Joao C.; Fischer, Florian; Gebru, Alemseged Aregay; Gona, Philimon; Gupta, Rajeev; Hankey, Graeme J.; Jonas, Jost B.; Judd, Suzanne E.; Khang, Young Ho; Khosravi, Ardeshir; Kim, Yun Jin; Kimokoti, Ruth W.; Kokubo, Yoshihiro; Kolte, Dhaval; Lopez, Alan; Lotufo, Paulo A.; Malekzadeh, Reza; Melaku, Yohannes Adama; Mensah, George A.; Misganaw, Awoke; Mokdad, Ali H.; Moran, Andrew E.; Nawaz, Haseeb; Neal, Bruce; Ngalesoni, Frida Namnyak; Ohkubo, Takayoshi; Pourmalek, Farshad; Rafay, Anwar; Rai, Rajesh Kumar; Rojas-Rueda, David; Sampson, Uchechukwu K.; Santos, Itamar S.; Sawhney, Monika; Schutte, Aletta E.; Sepanlou, Sadaf G.; Shifa, Girma Temam; Shiue, Ivy; Tedla, Bemnet Amare; Thrift, Amanda G.; Tonelli, Marcello; Truelsen, Thomas; Tsilimparis, Nikolaos; Ukwaja, Kingsley Nnanna; Uthman, Olalekan A.; Vasankari, Tommi; Venketasubramanian, Narayanaswamy; Vlassov, Vasiliy Victorovich; Vos, Theo; Westerman, Ronny; Yan, Lijing L.; Yano, Yuichiro; Yonemoto, Naohiro; El Sayed Zaki, Maysaa; Murray, Christopher J.L.

In: JAMA - Journal of the American Medical Association, Vol. 317, No. 2, 10.01.2017, p. 165-182.

Research output: Contribution to journalArticle

Forouzanfar, MH, Liu, P, Roth, GA, Ng, M, Biryukov, S, Marczak, L, Alexander, L, Estep, K, Abate, KH, Akinyemiju, TF, Ali, R, Alvis-Guzman, N, Azzopardi, P, Banerjee, A, Bärnighausen, T, Basu, A, Bekele, T, Bennett, DA, Biadgilign, S, Catalá-López, F, Feigin, VL, Fernandes, JC, Fischer, F, Gebru, AA, Gona, P, Gupta, R, Hankey, GJ, Jonas, JB, Judd, SE, Khang, YH, Khosravi, A, Kim, YJ, Kimokoti, RW, Kokubo, Y, Kolte, D, Lopez, A, Lotufo, PA, Malekzadeh, R, Melaku, YA, Mensah, GA, Misganaw, A, Mokdad, AH, Moran, AE, Nawaz, H, Neal, B, Ngalesoni, FN, Ohkubo, T, Pourmalek, F, Rafay, A, Rai, RK, Rojas-Rueda, D, Sampson, UK, Santos, IS, Sawhney, M, Schutte, AE, Sepanlou, SG, Shifa, GT, Shiue, I, Tedla, BA, Thrift, AG, Tonelli, M, Truelsen, T, Tsilimparis, N, Ukwaja, KN, Uthman, OA, Vasankari, T, Venketasubramanian, N, Vlassov, VV, Vos, T, Westerman, R, Yan, LL, Yano, Y, Yonemoto, N, El Sayed Zaki, M & Murray, CJL 2017, 'Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015', JAMA - Journal of the American Medical Association, vol. 317, no. 2, pp. 165-182. https://doi.org/10.1001/jama.2016.19043
Forouzanfar, Mohammad H. ; Liu, Patrick ; Roth, Gregory A. ; Ng, Marie ; Biryukov, Stan ; Marczak, Laurie ; Alexander, Lily ; Estep, Kara ; Abate, Kalkidan Hassen ; Akinyemiju, Tomi F. ; Ali, Raghib ; Alvis-Guzman, Nelson ; Azzopardi, Peter ; Banerjee, Amitava ; Bärnighausen, Till ; Basu, Arindam ; Bekele, Tolesa ; Bennett, Derrick A. ; Biadgilign, Sibhatu ; Catalá-López, Ferrán ; Feigin, Valery L. ; Fernandes, Joao C. ; Fischer, Florian ; Gebru, Alemseged Aregay ; Gona, Philimon ; Gupta, Rajeev ; Hankey, Graeme J. ; Jonas, Jost B. ; Judd, Suzanne E. ; Khang, Young Ho ; Khosravi, Ardeshir ; Kim, Yun Jin ; Kimokoti, Ruth W. ; Kokubo, Yoshihiro ; Kolte, Dhaval ; Lopez, Alan ; Lotufo, Paulo A. ; Malekzadeh, Reza ; Melaku, Yohannes Adama ; Mensah, George A. ; Misganaw, Awoke ; Mokdad, Ali H. ; Moran, Andrew E. ; Nawaz, Haseeb ; Neal, Bruce ; Ngalesoni, Frida Namnyak ; Ohkubo, Takayoshi ; Pourmalek, Farshad ; Rafay, Anwar ; Rai, Rajesh Kumar ; Rojas-Rueda, David ; Sampson, Uchechukwu K. ; Santos, Itamar S. ; Sawhney, Monika ; Schutte, Aletta E. ; Sepanlou, Sadaf G. ; Shifa, Girma Temam ; Shiue, Ivy ; Tedla, Bemnet Amare ; Thrift, Amanda G. ; Tonelli, Marcello ; Truelsen, Thomas ; Tsilimparis, Nikolaos ; Ukwaja, Kingsley Nnanna ; Uthman, Olalekan A. ; Vasankari, Tommi ; Venketasubramanian, Narayanaswamy ; Vlassov, Vasiliy Victorovich ; Vos, Theo ; Westerman, Ronny ; Yan, Lijing L. ; Yano, Yuichiro ; Yonemoto, Naohiro ; El Sayed Zaki, Maysaa ; Murray, Christopher J.L. / Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015. In: JAMA - Journal of the American Medical Association. 2017 ; Vol. 317, No. 2. pp. 165-182.
@article{109acd185e6241c5b9e49fdd257795c2,
title = "Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015",
abstract = "IMPORTANCE Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE To estimate the association between SBP of at least 110 to 115mmHg and SBP of 140mmHg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES Mean SBP level, cause-specific deaths, and health burden related to SBP (≤110-115mmHg and also≤140mmHg) by age, sex, country, and year. RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115mmHg increased from 73 119 (95{\%}uncertainty interval [UI], 67 949-78 241) to 81 373 (95{\%}UI, 76 814-85 770) per 100000, and SBP of 140mmHg or higher increased from 17 307 (95{\%}UI, 17 117-17 492) to 20526 (95{\%}UI, 20283-20746) per 100000. The estimated annual death rate per 100000associated with SBP of at least 110 to 115mmHg increased from 135.6 (95{\%}UI, 122.4-148.1) to 145.2 (95{\%}UI 130.3-159.9) and the rate for SBP of 140mmHg or higher increased from 97.9 (95{\%}UI, 87.5-108.1) to 106.3 (95{\%}UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115mmHg increased from 148 million (95{\%}UI, 134-162 million) to 211 million (95{\%} UI, 193-231 million), and for SBP of 140mmHg or higher, the loss increased from 95.9 million (95{\%}UI, 87.0-104.9 million) to 143.0million (95{\%}UI, 130.2-157.0million). The largest numbers of SBP-related deathswere caused by ischemic heart disease (4.9 million [95{\%}UI, 4.0-5.7 million]; 54.5{\%}), hemorrhagic stroke (2.0million [95{\%}UI, 1.6-2.3 million]; 58.3{\%}), and ischemic stroke (1.5 million [95{\%}UI, 1.2-1.8 million]; 50.0{\%}). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the globalDALYs related to SBP of at least 110 to 115mmHg. CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≤110-115 and≤140mmHg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115mmHg and 874 million adults had SBP of 140mmHg or higher.",
author = "Forouzanfar, {Mohammad H.} and Patrick Liu and Roth, {Gregory A.} and Marie Ng and Stan Biryukov and Laurie Marczak and Lily Alexander and Kara Estep and Abate, {Kalkidan Hassen} and Akinyemiju, {Tomi F.} and Raghib Ali and Nelson Alvis-Guzman and Peter Azzopardi and Amitava Banerjee and Till B{\"a}rnighausen and Arindam Basu and Tolesa Bekele and Bennett, {Derrick A.} and Sibhatu Biadgilign and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Feigin, {Valery L.} and Fernandes, {Joao C.} and Florian Fischer and Gebru, {Alemseged Aregay} and Philimon Gona and Rajeev Gupta and Hankey, {Graeme J.} and Jonas, {Jost B.} and Judd, {Suzanne E.} and Khang, {Young Ho} and Ardeshir Khosravi and Kim, {Yun Jin} and Kimokoti, {Ruth W.} and Yoshihiro Kokubo and Dhaval Kolte and Alan Lopez and Lotufo, {Paulo A.} and Reza Malekzadeh and Melaku, {Yohannes Adama} and Mensah, {George A.} and Awoke Misganaw and Mokdad, {Ali H.} and Moran, {Andrew E.} and Haseeb Nawaz and Bruce Neal and Ngalesoni, {Frida Namnyak} and Takayoshi Ohkubo and Farshad Pourmalek and Anwar Rafay and Rai, {Rajesh Kumar} and David Rojas-Rueda and Sampson, {Uchechukwu K.} and Santos, {Itamar S.} and Monika Sawhney and Schutte, {Aletta E.} and Sepanlou, {Sadaf G.} and Shifa, {Girma Temam} and Ivy Shiue and Tedla, {Bemnet Amare} and Thrift, {Amanda G.} and Marcello Tonelli and Thomas Truelsen and Nikolaos Tsilimparis and Ukwaja, {Kingsley Nnanna} and Uthman, {Olalekan A.} and Tommi Vasankari and Narayanaswamy Venketasubramanian and Vlassov, {Vasiliy Victorovich} and Theo Vos and Ronny Westerman and Yan, {Lijing L.} and Yuichiro Yano and Naohiro Yonemoto and {El Sayed Zaki}, Maysaa and Murray, {Christopher J.L.}",
year = "2017",
month = "1",
day = "10",
doi = "10.1001/jama.2016.19043",
language = "English (US)",
volume = "317",
pages = "165--182",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Global burden of hypertension and systolic blood pressure of at least 110 to 115mmHg, 1990-2015

AU - Forouzanfar, Mohammad H.

AU - Liu, Patrick

AU - Roth, Gregory A.

AU - Ng, Marie

AU - Biryukov, Stan

AU - Marczak, Laurie

AU - Alexander, Lily

AU - Estep, Kara

AU - Abate, Kalkidan Hassen

AU - Akinyemiju, Tomi F.

AU - Ali, Raghib

AU - Alvis-Guzman, Nelson

AU - Azzopardi, Peter

AU - Banerjee, Amitava

AU - Bärnighausen, Till

AU - Basu, Arindam

AU - Bekele, Tolesa

AU - Bennett, Derrick A.

AU - Biadgilign, Sibhatu

AU - Catalá-López, Ferrán

AU - Feigin, Valery L.

AU - Fernandes, Joao C.

AU - Fischer, Florian

AU - Gebru, Alemseged Aregay

AU - Gona, Philimon

AU - Gupta, Rajeev

AU - Hankey, Graeme J.

AU - Jonas, Jost B.

AU - Judd, Suzanne E.

AU - Khang, Young Ho

AU - Khosravi, Ardeshir

AU - Kim, Yun Jin

AU - Kimokoti, Ruth W.

AU - Kokubo, Yoshihiro

AU - Kolte, Dhaval

AU - Lopez, Alan

AU - Lotufo, Paulo A.

AU - Malekzadeh, Reza

AU - Melaku, Yohannes Adama

AU - Mensah, George A.

AU - Misganaw, Awoke

AU - Mokdad, Ali H.

AU - Moran, Andrew E.

AU - Nawaz, Haseeb

AU - Neal, Bruce

AU - Ngalesoni, Frida Namnyak

AU - Ohkubo, Takayoshi

AU - Pourmalek, Farshad

AU - Rafay, Anwar

AU - Rai, Rajesh Kumar

AU - Rojas-Rueda, David

AU - Sampson, Uchechukwu K.

AU - Santos, Itamar S.

AU - Sawhney, Monika

AU - Schutte, Aletta E.

AU - Sepanlou, Sadaf G.

AU - Shifa, Girma Temam

AU - Shiue, Ivy

AU - Tedla, Bemnet Amare

AU - Thrift, Amanda G.

AU - Tonelli, Marcello

AU - Truelsen, Thomas

AU - Tsilimparis, Nikolaos

AU - Ukwaja, Kingsley Nnanna

AU - Uthman, Olalekan A.

AU - Vasankari, Tommi

AU - Venketasubramanian, Narayanaswamy

AU - Vlassov, Vasiliy Victorovich

AU - Vos, Theo

AU - Westerman, Ronny

AU - Yan, Lijing L.

AU - Yano, Yuichiro

AU - Yonemoto, Naohiro

AU - El Sayed Zaki, Maysaa

AU - Murray, Christopher J.L.

PY - 2017/1/10

Y1 - 2017/1/10

N2 - IMPORTANCE Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE To estimate the association between SBP of at least 110 to 115mmHg and SBP of 140mmHg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES Mean SBP level, cause-specific deaths, and health burden related to SBP (≤110-115mmHg and also≤140mmHg) by age, sex, country, and year. RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115mmHg increased from 73 119 (95%uncertainty interval [UI], 67 949-78 241) to 81 373 (95%UI, 76 814-85 770) per 100000, and SBP of 140mmHg or higher increased from 17 307 (95%UI, 17 117-17 492) to 20526 (95%UI, 20283-20746) per 100000. The estimated annual death rate per 100000associated with SBP of at least 110 to 115mmHg increased from 135.6 (95%UI, 122.4-148.1) to 145.2 (95%UI 130.3-159.9) and the rate for SBP of 140mmHg or higher increased from 97.9 (95%UI, 87.5-108.1) to 106.3 (95%UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115mmHg increased from 148 million (95%UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140mmHg or higher, the loss increased from 95.9 million (95%UI, 87.0-104.9 million) to 143.0million (95%UI, 130.2-157.0million). The largest numbers of SBP-related deathswere caused by ischemic heart disease (4.9 million [95%UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0million [95%UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95%UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the globalDALYs related to SBP of at least 110 to 115mmHg. CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≤110-115 and≤140mmHg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115mmHg and 874 million adults had SBP of 140mmHg or higher.

AB - IMPORTANCE Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE To estimate the association between SBP of at least 110 to 115mmHg and SBP of 140mmHg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES Mean SBP level, cause-specific deaths, and health burden related to SBP (≤110-115mmHg and also≤140mmHg) by age, sex, country, and year. RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115mmHg increased from 73 119 (95%uncertainty interval [UI], 67 949-78 241) to 81 373 (95%UI, 76 814-85 770) per 100000, and SBP of 140mmHg or higher increased from 17 307 (95%UI, 17 117-17 492) to 20526 (95%UI, 20283-20746) per 100000. The estimated annual death rate per 100000associated with SBP of at least 110 to 115mmHg increased from 135.6 (95%UI, 122.4-148.1) to 145.2 (95%UI 130.3-159.9) and the rate for SBP of 140mmHg or higher increased from 97.9 (95%UI, 87.5-108.1) to 106.3 (95%UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115mmHg increased from 148 million (95%UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140mmHg or higher, the loss increased from 95.9 million (95%UI, 87.0-104.9 million) to 143.0million (95%UI, 130.2-157.0million). The largest numbers of SBP-related deathswere caused by ischemic heart disease (4.9 million [95%UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0million [95%UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95%UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the globalDALYs related to SBP of at least 110 to 115mmHg. CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≤110-115 and≤140mmHg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115mmHg and 874 million adults had SBP of 140mmHg or higher.

UR - http://www.scopus.com/inward/record.url?scp=85010540246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010540246&partnerID=8YFLogxK

U2 - 10.1001/jama.2016.19043

DO - 10.1001/jama.2016.19043

M3 - Article

C2 - 28097354

AN - SCOPUS:85010540246

VL - 317

SP - 165

EP - 182

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 2

ER -