Rates of elevated systolic blood pressure (BP) have increased globally from 1990 to 2015, with an estimated 3.5 billion adults with a systolic BP ≥110 to 115 mm Hg and 874 million adults with a systolic BP ≥140 mm Hg, according to research published in JAMA.

Christopher J.L. Murray, DPhil, and colleagues conducted a comparative risk assessment of health loss as it related to systolic BP across 195 countries and territories from 1990 to 2015. Primary outcomes included mean systolic BP, cause-specific deaths, and health burden related to systolic BP (≥110 to 115 mm Hg; ≥140 mm Hg). Outcomes were assessed by age, sex, country, and year.

Dr Murray and colleagues examined 844 studies published between 1980 and 2015 that included 8.69 million participants. During the study period, the researchers found that the rate of systolic BP ≥110 to 115 mm Hg increased from 73,119 to 81,373 per 100,000 (95% uncertainty interval [UI], 67,949-78,241, and 76,814-85,770, respectively). The rate of systolic BP ≥140 mm Hg increased from 17,307 to 20,526 per 100,000 (95% UI, 17,117-17,492 and 20,283-20,746, respectively). The estimated annual death rate also increased over time for both ≥110 to 115 mm Hg and ≥140 mm Hg systolic BP from 135.6 to 145.2 deaths per 100,000 (95% UI, 122.4-148.1 and 130.3-159.9, respectively) and from 97.9 to 106.3 deaths per 100,000, respectively (95% UI, 95% UI, 87.5-108.1 and 94.6-118.1, respectively).

In addition to increases in systolic BP and annual death rates, the study investigators also determined projected disability-adjusted life-years (DALYs) associated with a systolic BP ≥110 to 115 mm Hg and ≥140 mm Hg. Projected DALYs associated with systolic BP ≥110 to 115 mm Hg increased from 148 million to 211 million (95% UI, 134-162 million and 193-231 million, respectively); projected DALYs associated with a systolic BP ≥140 mm Hg increased from 5.2 million to 7.8 million (95% UI, 4.6-5.7 million and 7.0-8.7 million, respectively).

DALYs were distributed by both level of systolic BP and cause. Globally, 29% of DALYs linked to systolic BP ≥110 to 115 mm Hg occurred in individuals who had systolic BP between 115 and 140 mm Hg, 26% of DALYs occurred in individuals with systolic BP between 140 and 150 mm Hg, and 45% of DALYs occurred in individuals with a systolic BP ≥150 mm Hg. The researchers found that regardless of systolic BP level, ischemic heart disease was “the most important contributor to systolic BP-related deaths,” closely follow by hemorrhagic and ischemic stroke.

Regionally, DALY rates varied greatly: 1025.66 (95% UI, 916.51-1136.97) in the Asia-Pacific high-income region to 7022.18 (95% UI, 5259.73-9652.2) in Oceania. DALYs standardized by age with a systolic BP ≥110 to 115 mm Hg were highest in Oceania, followed by Eastern Europe, Central Asia, and Central sub-Saharan Africa. “Relative to life expectancy, the burden of systolic BP was comparatively high in East Asia and Central Europe,” the researchers wrote.

“[Systolic BP] of at least 110 mm Hg has been related to multiple cardiovascular and kidney outcomes, including ischemic heart disease, cerebrovascular disease, and chronic kidney disease,” according to a JAMA press release.2 “Quantifying the levels of systolic BP is important to guide prevention policies and interventions.”

“These estimates are concerning, given that in 2015, an estimated 3.5 billion individuals had an SBP level of at least 110 to 115 mm Hg,” the researchers concluded.

In an accompanying editorial,3 Mark D. Huffman, MD, MPH, and Donald M. Lloyd-Jones, MD, ScM, both from the department of preventive medicine and the division of cardiology at Northwestern University Feinberg School of Medicine in Chicago, noted that “several key takeaways” have emerged based on this latest data, including the need for both “broad population-level and high-risk clinical strategies” aimed at reducing the burden of cardiovascular diseases (CVD) related to systolic BP and preventing clinical hypertension and prehypertension.

“These data cannot inform clinical practice guidelines regarding appropriate levels for initiation of blood pressure lowering therapy… However, these data strengthen the case to lower the risk for CVD in those with SBP of 140 mm Hg or higher by all effective means available,” they wrote

Study Limitations

  • The burden of high diastolic BP was not included in this study.
  • Systolic BP burden was only assessed in individuals aged 25 years and older.
  • There is a need for population-based health surveys in all countries and surveys that track treatment access.
  • The relative risk of each 10-mm increment in BP was assumed to be the same from 115 mm Hg to above 200 mm Hg.

Disclosures: Dr Ng reports receiving grants from the Bill and Melinda Gates Foundation and IBM Watson Health. Dr Hankey reports receiving honoraria from AC Immune, Bayer, and Medscape/WebMD. Dr Lotufo reports receiving honoraria from AbbVie Brazil. Dr Santos reports receiving a grant from the Sao Paulo Research Foundation. Dr Schutte reports receiving fees from Boehringer-Ingelheim, Omron Healthcare, and Aspen Pharmaceuticals. Dr Thrift reports receiving grants from the National Health and Medical Research Council. Dr Vos reports receiving a grant from the Bill and Melinda Gates Foundation. Dr Yan reports receiving a grant from the National Natural Sciences Foundation of China. No additional conflicts of interest were reported. 

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  1. Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317(2):165-182. doi: 10.1001/jama.2016.19043
  2. Rate of elevated systolic blood pressure increases globally, along with associated deaths [news release]. Chicago, IL: JAMA Network Media Relations; January 10, 2017. http://media.jamanetwork.com/news-item/rate-of-elevated-systolic-blood-pressure-increases-globally-along-with-associated-deaths. Accessed January 17, 2017.
  3. Huffman MD, Lloyd-Jones DM. Global burden of raised blood pressure: coming into focus. JAMA. 2017;317(2):142-143. doi: 10.1001/jama.2016.19685