Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015
Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015
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DOI：
10.1001/jama.2016.19043
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发表时间：
2017-01-10
影响因子：
120.7
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Forouzanfar, Mohammad H.;Liu, Patrick;Murray, Christopher J. L.
收缩压升高是全球主要的健康风险。量化收缩压水平对指导预防政策和干预措施具有重要意义。目的评估1990-2015年195个国家和地区按年龄和性别划分的不同死因和残疾负担与至少110 - 115 mm Hg和140 mm Hg或更高的收缩压之间的关系。设计对与收缩压相关的健康损失进行比较风险评估。SBP的估计分布基于来自154个国家的844项研究（发表于1980-2015年），涉及869万名参与者。使用时空高斯过程回归对每个年龄、性别、国家和年份的平均收缩压和调整方差进行估计。有充分证据表明与高收缩压有因果关系的疾病（如缺血性心脏病、缺血性卒中和出血性卒中）被纳入初步分析。按年龄、性别、国家和年份划分的平均收缩压水平、原因特异性死亡和与收缩压相关的健康负担（> = 110-115mmHg和>= 140 mmhg）。结果1990-2015年间，舒张压≥110 ~ 115 mm Hg的发生率从73 / 119（95%不确定区间[UI]， 67 949 ~ 78 241）增加到81 373 (95% UI, 76 814 ~ 85 770) / 10万人，舒张压≥140 mm Hg的发生率从17 307 （95% UI, 17 117 ~ 17 492）增加到20526 (95% UI, 20283 ~ 20746) / 10万人。与舒张压≥110 - 115 mm Hg相关的10万人年死亡率从135.6 （95% UI, 122.4-148.1）增加到145.2 (95% UI, 130.3-159.9)，舒张压≥140 mm Hg的死亡率从97.9 （95% UI, 87.5-108.1）增加到106.3 （95% UI, 94.6-118.1）。与收缩压≥110 - 115 mm Hg相关的残疾调整生命年（DALYs）损失从1.48亿（95% UI, 1.34 - 1.62亿）增加到2.11亿（95% UI, 1.93 - 2.31亿），收缩压≥140 mm Hg，损失从520万（95% UI， 460 - 570万）增加到780万（95% UI， 700 - 870万）。sbp相关死亡人数最多的是缺血性心脏病（490万[95% UI， 400 - 570万]；54.5%）、出血性卒中（200万[95% UI， 160 - 230万]；58.3%）和缺血性卒中（150万[95% UI， 120 - 180万]；50.0%）。2015年，中国、印度、俄罗斯、印度尼西亚和美国占全球与收缩压相关的至少110-115 mm Hg的DALYs的一半以上。结论和相关性在国际调查中，尽管一些估计存在不确定性，但收缩压升高的比率（>= 110-115和>= 140 mm Hg）在1990年至2015年间大幅增加，与收缩压升高相关的DALYs和死亡人数也有所增加。基于该样本的预测表明，2015年，估计有35亿成年人的收缩压至少为110至115毫米汞柱，8.74亿成年人的收缩压为140毫米汞柱或更高。版权所有2016美国医学协会。版权所有。
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 115 mm Hg and SBP of 140 mm Hg 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 >= 140 mm Hg) by age, sex, country, and year.RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg 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 140 mm Hg 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 100000 associated with SBP of at least 110 to 115 mm Hg 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 140 mm Hg 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 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). 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 global DALYs related to SBP of at least 110 to 115 mm Hg.CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (>= 110-115 and >= 140 mm Hg) 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 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher. Copyright 2016 American Medical Association. All rights reserved.