Hypertension, Related Mortality Rising Globally

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Elevated blood pressure is on the rise around the world, with an increasing impact on mortality, according to a large international study.

Individuals with systolic blood pressures above 110 mm Hg grew in ranks from 73,119 for every 100,000 people in 1990 to 81,373 per 100,000 in 2015. At the same time, it became more common for people to have systolic blood pressures over 140 mm Hg (17,307 for every 100,000 people in 1990 versus 20,526 in 2015), according to Christopher J.L. Murray, DPhil, of University of Washington's Institute for Health Metrics and Evaluation in Seattle, and colleagues.

Deaths were on the rise too, regardless of whether patients had a systolic blood pressure surpassing 110 mm Hg (135.6 versus 145.2) or 140 mm Hg (97.9 to 106.3), the authors noted. Their study appeared online in the Journal of the American Medical Association.

The proportion of deaths related to elevated systolic blood pressure globally was 54.5% in ischemic heart disease, 58.3% in hemorrhagic stroke, and 50.0% in ischemic stroke.

Murray and colleagues performed a subanalysis of the colossal Global Burden of Disease, Injuries, and Risk Factor (GBD) 2015 study, which included 8.69 million participants with elevated systolic blood pressure. They pooled international surveys from 195 countries and territories.

"Compared with all other specific risks quantified in the GBD, systolic blood pressure of at least 110 to 115 mm Hg was the leading global contributor to preventable death in 2015. These estimates are concerning given that in 2015, an estimated 3.5 billion individuals had an systolic blood pressure level of at least 110 to 115 mm Hg," they wrote.

"Although the drivers of trends in hypertension were not quantified in this study, other research has documented that dietary salt intake, fruit and vegetable consumption, overweight and obesity, and physical activity have also changed substantially over the same time period."

Loss of disability-adjusted life-years associated with systolic blood pressure of at least 110 mm Hg increased from 148 million to 211 million; for systolic blood pressure of 140 mm Hg or higher, the loss increased from 5.2 million to 7.8 million.

The bulk of life-years lost from systolic blood pressure exceeding 110 mm Hg accrued in China, India, Russia, Indonesia, and the United States, according to the study.

"These data cannot inform clinical practice guidelines regarding appropriate levels for initiation of blood pressure-lowering therapy or goal levels for treatment," commented Mark D. Huffman, MD, MPH, and Donald M. Lloyd-Jones, MD, ScM, both of Chicago's Northwestern University, in an accompanying editorial.

"However, these data strengthen the case to lower the risk for cardiovascular diseases in those with systolic blood pressure of 140 mm Hg or higher by all effective means available, including improving uptake of healthy diets, minimizing weight gain or promoting weight loss in overweight and obese individuals, and promoting uptake and adherence to effective blood pressure–lowering drugs as well as management of related cardiovascular risk."