Elsevier

The Lancet

Volume 371, Issue 9623, 3–9 May 2008, Pages 1513-1518
The Lancet

Articles
Global burden of blood-pressure-related disease, 2001

https://doi.org/10.1016/S0140-6736(08)60655-8Get rights and content

Summary

Background

Few studies have assessed the extent and distribution of the blood-pressure burden worldwide. The aim of this study was to quantify the global burden of disease related to high blood pressure.

Methods

Worldwide burden of disease attributable to high blood pressure (≥115 mm Hg systolic) was estimated for groups according to age (≥30 years), sex, and World Bank region in the year 2001. Population impact fractions were calculated with data for mean systolic blood pressure, burden of deaths and disability-adjusted life years (DALYs), and relative risk corrected for regression dilution bias.

Findings

Worldwide, 7·6 million premature deaths (about 13·5% of the global total) and 92 million DALYs (6·0% of the global total) were attributed to high blood pressure. About 54% of stroke and 47% of ischaemic heart disease worldwide were attributable to high blood pressure. About half this burden was in people with hypertension; the remainder was in those with lesser degrees of high blood pressure. Overall, about 80% of the attributable burden occurred in low-income and middle-income economies, and over half occurred in people aged 45–69 years.

Interpretation

Most of the disease burden caused by high blood pressure is borne by low-income and middle-income countries, by people in middle age, and by people with prehypertension. Prevention and treatment strategies restricted to individuals with hypertension will miss much blood-pressure-related disease.

Introduction

Cardiovascular disease is now endemic worldwide and no longer limited to economically developed countries.1, 2 About a third of all deaths in middle-income countries are caused by cardiovascular disease; this proportion is similar to that in many developed nations.1 Furthermore, rates of disease are generally much higher in developing than in developed countries—for example, age-specific stroke rates in Tanzania are about three to six times higher than those in the UK.3 Cardiovascular disease also typically occurs at a younger age in developing than in developed countries:1 for example, about 52% of deaths from such disorders in India occur before 70 years of age, compared with 23% in established-market economies.4, 5

In the context of this large and growing disease burden, strategies to improve population health require consistent and comprehensive measures of the contribution of major risk factors to premature mortality and disability.6, 7 These estimates can elucidate the potential for prevention and provide an important input into health planning and other cost-utility decisions. Therefore, the importance of modifiable cardiovascular health risks, such as blood pressure,8, 9, 10, 11, 12, 13, 14 should not be overestimated or underestimated.

This report provides updated estimates of the global burden of disease attributable to high blood pressure by age and sex for adults and by World Bank region. It also summarises work done as part of the disease control priorities in developing countries Global Burden of Disease study (DCP2).15, 16

Section snippets

Data collection

The population attributable risk method was used to estimate disease burden related to high blood pressure.17 Population attributable risk (or population attributable burden) is the proportional reduction in average disease risk over a specified time interval that would be achieved by eliminating the exposure of interest from the population if the distributions of other risk factors remain unchanged.18 The key data inputs for population attributable risk are current blood pressure levels,

Results

About 54% of stroke, 47% of ischaemic heart disease, 75% of hypertensive disease, and 25% of other cardiovascular disease worldwide was attributable to high blood pressure. In total, about 7·6 million (13·5%) of all deaths and 92 million (6·0%) of all DALYs in the year 2001 were attributable to high blood pressure as a cause of these diseases. Burden attributable to high blood pressure was greatest for stroke and ischaemic heart disease (table 1).

Over 80% of the attributable burden of disease

Discussion

This study has shown that about 7·6 million deaths (about 13·5% of the total) and 92 million DALYs (6·0% of the total) worldwide were attributed to high blood pressure in 2001. Overall, more than 80% of the attributable burden of disease was in low-income and middle-income regions, and a greater proportion of the burden was in young age groups in these regions than it was in high-income regions. High blood pressure was a major health issue in all world regions, and it accounted for more than a

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