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 1018 population-based studies with blood pressure measurements
on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood
pressure (SBP), mean diastolic blood pressure (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 (probittransformed)
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 2005–16, at the same level of population mean SBP and DBP, men and
women in South Asia and in Central Asia, the Middle East and North Africa would have
the highest prevalence of raised blood pressure, and men and women in the highincome
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.