Reducing the global burden of blood pressure-related cardiovascular disease
Rodgers A., Lawes C., MacMahon S.
Objective: To assist in prioritisation for strategies for the control of cardiovascular disease (CVD) worldwide, by estimating the size of the contribution of elevated blood pressure and, more importantly, the likely effects of its modification. Design: We estimated the size of the disease burden attributable to increased blood pressure in Eastern Asia and describe a method for estimating the likely effects of blood pressure lowering strategies. Methods: Attributable risk estimates were calculated to assess the likely contribution of increased blood pressure to death from CVD in Asia. Estimates were also made of the possible effects of population-wide (2% lower diastolic blood pressure [DBP] for all) and targeted (7% lower DBP for those with DBP ≥ 95 mmHg) blood pressure lowering interventions. These estimates were based on data from several sources, including surveys of blood pressure values in Asian populations, estimates of the incidence of cardiovascular disease in Asia, studies of the associations of blood pressure with cardiovascular disease risks in Asia and elsewhere, and randomized trials of blood pressure lowering treatments. Results: The results suggest that DBP values of 80 mmHg or more account for about 57% of all stroke deaths and about 24% of all coronary heart disease deaths in Eastern Asian populations. The two intervention strategies proposed would each be expected to avert about 1 in 6 stroke deaths and about 1 in 20 coronary heart disease deaths. This would amount to about 1 million deaths per year throughout Asia by 2020, with about half of those deaths averted in the People's Republic of China. The benefits of the two different approaches would be approximately additive. Conclusions: Increased blood pressure levels are directly responsible for the majority of stroke deaths (more than 50%) and a substantial minority of deaths from coronary heart disease (about 25%) in Eastern Asia. Both modest population-wide blood pressure reductions and more moderate targeted reductions in those with hypertension could be expected to produce large reductions in the burden of cardiovascular disease in these and other Asian regions. (C) 2000 Lippincott Williams and Wilkins.