| Part 1 Study of the global and regional burden of disease attributable to HSBPBackground: High systolic blood pressure（HSBP）remains the leading risk factor for mortality worldwide.Although many blood pressure control measures have been implemented worldwide over the last 40 years,the global average blood pressure levels has not improved and the prevalence of high systolic blood pressure has increased.However,there are few comprehensive data that reveal the burden of disease attributable to HSBP and its variation at the global and regional levels.Objective: To characterize the global,regional and national variation in the burden of disease attributable to HSBP and its differences in order to optimise prevention and control strategies.Methods: Based on data and evaluation methods from the Global Burden of Diseases Study 2019,we compared the age-standardized mortality rate（ASMR）,the agestandardized rate of disability-adjusted life years（ASDR）,the age-standardized rate of years of life lost prematurely,and the age-standardized rate of years lived with disability（ASYR）attributable to HSBP in the Global,5 SDI regions,21 GBD regions and 204 countries and territories during 1990-2019.We used the estimated annual percentage change（EAPC）to demonstrate the trends and variations of the burden attributable to HSBP.Besides,we visualised the burden of disease attributable to HSBP in different regions during 1990-2019.Results: Globally,between 1990 and 2019,the ASMR attributable to HSBP（unit: per100,000 people）increased from 197.87（95% uncertainty interval（UI）: 174.93,220.93）to138.88（95% UI: 121.25,155.73）,the EAPC was-1.32（95% CI:-1.36,-1.27）;While the ASYR（unit: per 100,000 people）attributable to HSBP increased slightly from 256.03（95%UI: 184.76,330.07）to 258.54（95% UI: 185.85,331.93）,the EAPC was 0.09（95% CI: 0.06,0.11）;The ASDR（unit: per 100,000 people）attributable to HSBP has decreased from3953.92（95% UI: 3557.53,4359.13）to 2885.57（95% UI: 2580.75,3201.05）,the EAPC was-1.17（95% CI:-1.22,-1.13）。Regionally,in 2019,the Low-SDI region had the highest ASMR attributable to HSBP of 169.85（95% UI: 147.99,191.20）;the High-SDI region had the lowest ASMR attributable to HSBP of 69.76（95% UI: 58.67,79.66）;the Middle-SDI region had the highest ASYR attributable to HSBP of 300.25（95% UI: 215.76,387.30）;the Low-SDI region had the lowest ASYR attributable to HSBP of 208.56（95% UI: 151.69,269.10）;the Low-SDI region had the highest ASDR attributable to HSBP of 3682.42（95% UI: 3212.75,4153.97）;the High-SDI region had the lowest ASDR attributable to HSBP of 1385.57（95%UI: 1222.65,1545.55）;In general,the highest disease burden attributable to HSBP mainly in Asian and African countries.Globally,in 2019,the ASMR attributable to HSBP was 160.13（95% UI: 138.91,180.79）in male,119.66（95% UI: 102.33,136.86）in female;The ASDR attributable to HSBP was 3448.86（95% UI: 3060.06,3837.69）in male,2354.72（95% UI: 2075.57,2634.68）in female.In addition,older age groups are more affected by HSBP.Conclusions: Globally,between 1990 and 2019,we found a significant decrease in ASMR attributable to HSBP,while the ASYR attributable to HSBP did not substantially improve.The burden of disease attributable to HSBP has improved well in High SDI regions,and the majority of HSBP burden has shifted from High-middle sociodemographic index（SDI）regions to lower SDI regions,but the declining trend in HSBP burden in High SDI regions has stalled in recent years.Part 2 Study on the burden of different diseases attributable to HSBPBackground: In part 1,we found the majority of HSBP burden has shifted from Highmiddle sociodemographic index（SDI）regions to lower SDI regions.However,few systematic studies demonstrated disparities in the burden of disease of different HSBPassociated diseases.In order to clarify the extent to which HSBP affects different diseases and to identify priorities for prevention and management,we did part 2.Objective: This study aimed to estimate the disease burden of HSBP-associated diseases attributable to HSBP by region,sex,and age.Methods: Based on data and evaluation methods from the Global Burden of Diseases Study 2019,we compared the age-standardized mortality rate（ASMR）,the agestandardized rate of disability-adjusted life years（ASDR）of HSBP-associated diseases attributable to HSBP.We also used the estimated annual percentage change（EAPC）to estimate trends of age-standardized mortality rate（ASMR）and the age-standardized rate of disability-adjusted life years（ASDRs）of HSBP-associated diseases attributable to HSBP during 1990-2019.Besides,we compared the population attributable fraction（PAF）of ASMR of HSBP-associated diseases attributable to HSBP in 1990 and 2019,and its percentage change between 1990 and 2019.Further,we analyzed cause-specific burdens attributable to HSBP by sex,age,year,and region.Results: Globally,between 1990 and 2019,the EAPC of ASMR was 0.70（95% CI: 0.60,0.80）in chronic kidney disease（CKD）,0.73（95% CI: 0.42,1.04）in endocarditis,and the EAPC of ASMR was lower than 0 in other 10 diseases,as well as their 95% CI;The EAPC of ASDR was 0.61（95% CI: 0.52,0.70）in CKD,0.46（95% CI: 0.25,0.67）in endocarditis,and the EAPC of ASDR was lower than 0 in other 10 diseases,as well as their 95% CI.In the 12 GBD level 3 causes,the PAF of ASMR of HSBP-associated diseases attributable to HSBP changed slightly.Through visual analysis we found that the death burden associated with ischemic heart disease,atrial fibrillation and flutter,aortic aneurysm and peripheral arterial disease remained increasing in Low,Low-middle and Middle SDI regions,while the burden of most diseases associated with HSBP has improved in High SDI regions.Conclusions: Globally,the ASMR and ASDR of CKD and endocarditis were still increasing.Regionally,the death burden associated with ischemic heart disease,atrial fibrillation and flutter,aortic aneurysm and peripheral arterial disease remained increasing in Low,Low-middle and Middle SDI regions.The burden of most diseases associated with HSBP has improved in High SDI regions,but the downward trend of disease burden has stalled in recent years.In addition,the burden of disease attributable to HSBP is higher in men than in women for most diseases.Middle-aged people with CVDs composed the major subgroup affected by HSBP while older people had the highest ASMRs associated with HSBP. |
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