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Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants

(2017) LANCET. 389(10064). p.37-55
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Abstract
Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19.1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127.0 mm Hg (95% credible interval 125.7-128.3) in men and 122.3 mm Hg (121.0-123.6) in women; age-standardised mean diastolic blood pressure was 78.7 mm Hg (77.9-79.5) for men and 76.7 mm Hg (75.9-77.6) for women. Global age-standardised prevalence of raised blood pressure was 24.1% (21.4-27.1) in men and 20.1% (17.8-22.5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.
Keywords
CARDIOVASCULAR RISK-FACTORS, HEALTH EXAMINATION SURVEYS, HYPERTENSION, PREVALENCE, UNITED-STATES, SYSTEMATIC ANALYSIS, GENDER-DIFFERENCES, INCOME COUNTRIES, SECULAR TRENDS, MONICA PROJECT, GLOBAL BURDEN

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MLA
Zhou, Bin, et al. “Worldwide Trends in Blood Pressure from 1975 to 2015 : A Pooled Analysis of 1479 Population-Based Measurement Studies with 19.1 Million Participants.” LANCET, vol. 389, no. 10064, 2017, pp. 37–55, doi:10.1016/S0140-6736(16)31919-5.
APA
Zhou, B., Bentham, J., Di Cesare, M., Bixby, H., Danaei, G., Cowan, M. J., … Zuniga Cisneros, J. (2017). Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. LANCET, 389(10064), 37–55. https://doi.org/10.1016/S0140-6736(16)31919-5
Chicago author-date
Zhou, Bin, James Bentham, Mariachiara Di Cesare, Honor Bixby, Goodarz Danaei, Melanie J Cowan, Christopher J Paciorek, et al. 2017. “Worldwide Trends in Blood Pressure from 1975 to 2015 : A Pooled Analysis of 1479 Population-Based Measurement Studies with 19.1 Million Participants.” LANCET 389 (10064): 37–55. https://doi.org/10.1016/S0140-6736(16)31919-5.
Chicago author-date (all authors)
Zhou, Bin, James Bentham, Mariachiara Di Cesare, Honor Bixby, Goodarz Danaei, Melanie J Cowan, Christopher J Paciorek, Gitanjali Singh, Kaveh Hajifathalian, James E Bennett, Cristina Taddei, Ver Bilano, Rodrigo M Carrillo-Larco, Shirin Djalalinia, Shahab Khatibzadeh, Charles Lugero, Niloofar Peykari, Wan Zhu Zhang, Yuan Lu, Gretchen A Stevens, Leanne M Riley, Pascal Bovet, Paul Elliott, Dongfeng Gu, Nayu Ikeda, Rod T Jackson, Michel Joffres, Andre Pascal Kengne, Tiina Laatikainen, Tai Hing Lam, Avula Laxmaiah, Jing Liu, J Jaime Miranda, Charles K Mondo, Hannelore K Neuhauser, Johan Sundstrom, Liam Smeeth, Maroje Soric, Mark Woodward, Majid Ezzati, Leandra Abarca-Gomez, Ziad A Abdeen, Hanan Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert Adams, Wichai Aekplakorn, Kaosar Afsana, Carlos A Aguilar-Salinas, Charles Agyemang, Alireza Ahmadvand, Wolfgang Ahrens, Rajaa Al Raddadi, Rihab Al Woyatan, Mohamed M Ali, Ala’a Alkerwi, Eman Aly, Philippe Amouyel, Antoinette Amuzu, Lars Bo Andersen, Sigmund A Anderssen, Lars Angquist, Ranjit Mohan Anjana, Daniel Ansong, Hajer Aounallah-Skhiri, Joana Araujo, Inger Ariansen, Tahir Aris, Nimmathota Arlappa, Krishna Aryal, Dominique Arveiler, Felix K Assah, Maria Cecilia F Assuncao, Maria Avdicova, Ana Azevedo, Fereidoun Azizi, Bontha V Babu, Suhad Bahijri, Nagalla Balakrishna, Piotr Bandosz, Jose R Banegas, Carlo M Barbagallo, Alberto Barcelo, Amina Barkat, Aluisio JD Barros, Mauro V Barros, Iqbal Bata, Anwar M Batieha, Louise A Baur, Robert Beaglehole, Habiba Ben Romdhane, Mikhail Benet, Lowell S Benson, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K Bhargava, Yufang Bi, Mukharram Bikbov, Peter Bjerregaard, Espen Bjertness, Cecilia Bjokelund, Anneke Blokstra, Simona Bo, Martin Bobak, Heiner Boeing, Jose G Boggia, Carlos P Boissonnet, Vanina Bongard, Pascal Bovet, Lutgart Braeckman, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, Hermann Brenner, Lizzy M Brewster, Graziella Bruno, HB (as) Bueno-de-Mesquita, Anna Bugge, Con Burns, Michael Bursztyn, Antonio Cabrera de Leon, Christine Cameron, Gunay Can, Ana Paula C Candido, Vincenzo Capuano, Viviane C Cardoso, Axel C Carlsson, Maria J Carvalho, Felipe F Casanueva, Felipe F Casanueva, Juan-Pablo Casas, Carmelo A Caserta, Snehalatha Chamukuttan, Angelique W Chan, Queenie Chan, Himanshu K Chaturvedi, Nishi Chaturvedi, Chien-Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching-Yu Cheng, Imane Cherkaoui Dekkaki, Angela Chetrit, Arnaud Chiolero, Shu-Ti Chiou, Adela Chirita-Emandi, Belong Cho, Yumi Cho, Jerzy Chudek, Renata Cifkova, Frank Claessens, Els Clays, Hans Concin, Cyrus Cooper, Rachel Cooper, Tara C Coppinger, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L Craig, Ana B Crujeiras, Juan J Cruz, Graziella D’Arrigo, Eleonora d’Orsi, Jean Dallongeville, Albertino Damasceno, Goodarz Danaei, Rachel Dankner, Thomas M Dantoft, Luc Dauchet, Gui De Backer, Dirk De Bacquer, Giovanni de Gaetano, Stefaan De Henauw, Delphine De Smedt, Mohan Deepa, Abbas Dehghan, Helene Delisle, Valerie Deschamps, Klodian Dhana, Augusto F Di Castelnuovo, Juvenal Soares Dias-da-Costa, Alejandro Diaz, Ty T Dickerson, Shirin Djalalinia, Ha TP Do, Annette J Dobson, Chiara Donfrancesco, Silvana P Donoso, Angela Doering, Kouamelan Doua, Wojciech Drygas, Virginija Dulskiene, Aleksandar Dzakula, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Robert Eggertsen, Ulf Ekelund, Jalila El Ati, Ute Ellert, Paul Elliott, Roberto Elosua, Rajiv T Erasmus, Cihangir Erem, Louise Eriksen, Jorge Escobedo-de la Pena, Alun Evans, David Faeh, Caroline H Fall, Farshad Farzadfar, Francisco J Felix-Redondo, Trevor S Ferguson, Daniel Fernandez-Berges, Daniel Ferrante, Marika Ferrari, Catterina Ferreccio, Jean Ferrieres, Joseph D Finn, Krista Fischer, Bernhard Foeger, Leng Huat Foo, Ann-Sofie Forslund, Maria Forsner, Stephen P Fortmann, Heba M Fouad, Damian K Francis, Maria do Carmo Franco, Oscar H Franco, Guillermo Frontera, Flavio D Fuchs, Sandra C Fuchs, Yuki Fujita, Takuro Furusawa, Zbigniew Gaciong, Dickman Gareta, Sarah P Garnett, Jean-Michel Gaspoz, Magda Gasull, Louise Gates, Diana Gavrila, Johanna M Geleijnse, Anoosheh Ghasemian, Anup Ghimire, Simona Giampaoli, Francesco Gianfagna, Jonathan Giovannelli, Rebecca A Goldsmith, Helen Goncalves, Marcela Gonzalez Gross, Juan P Gonzalez Rivas, Frederic Gottrand, Sidsel Graff-Iversen, Dusan Grafnetter, Aneta Grajda, Ronald D Gregor, Tomasz Grodzicki, Anders Grontved, Grabriella Gruden, Vera Grujic, Dongfeng Gu, Ong Peng Guan, Vilmundur Gudnason, Ramiro Guerrero, Idris Guessous, Andre L Guimaraes, Martin C Gulliford, Johanna Gunnlaugsdottir, Marc Gunter, Prakash C Gupta, Oye Gureje, Beata Gurzkowska, Laura Gutierrez, Felix Gutzwiller, Farzad Hadaegh, Jytte Halkjaer, Ian R Hambleton, Rebecca Hardy, Rachakulla Harikumar, Jun Hata, Alison J Hayes, Jiang He, Marleen Elisabeth Hendriks, Ana Henriques, Leticia Hernandez Cadena, Herqutanto Herqutanto, Sauli Herrala, Ramin Heshmat, Ilpo Tapani Hihtaniemi, Sai Yin Ho, Suzanne C Ho, Michael Hobbs, Albert Hofman, Gonul Horasan Dinc, Claudia M Hormiga, Bernardo L Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Yonghua Hu, Jose Maria Huerta, Abdullatif S Husseini, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, M Mohsen Ibrahim, M Arfan Ikram, Vilma E Irazola, Muhammad Islam, Vanja Ivkovic, Masanori Iwasaki, Rod T Jackson, Jeremy M Jacobs, Tazeen Jafar, Konrad Jamrozik, Imre Janszky, Grazyna Jasienska, Bojan Jelakovic, Chao Qiang Jiang, Mattias Johansson, Jost B Jonas, Torben Jorgensen, Pradeep Joshi, Anne Juolevi, Gregor Jurak, Vesna Juresa, Rudolf Kaaks, Anthony Kafatos, Ofra Kalter-Leibovici, Nor Azmi Kamaruddin, Amir Kasaeian, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinanen-Kiukaanniemi, Roya Kelishadi, Han CG Kemper, Andre Pascal Kengne, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Young-Ho Khang, Kay-Tee Khaw, Stefan Kiechl, Japhet Killewo, Jeongseon Kim, Jurate Klumbiene, Elin Kolle, Patrick Kolsteren, Paul Korrovits, Seppo Koskinen, Katsuyasu Kouda, Slawomir Koziel, Peter Lund Kristensen, Steinar Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Diana Kuh, Urho M Kujala, Krzysztof Kula, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher Larijani, Lars E Laugsand, Avula Laxmaiah, Khanh Le Nguyen Bao, Tuyen D Le, Catherine Leclercq, Jeannette Lee, Jeonghee Lee, Terho Lehtimaki, Rampal Lekhraj, Luz M Leon-Munoz, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Hsien-Ho Lin, Xu Lin, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Jing Liu, Roberto Lorbeer, Paulo A Lotufo, Jose Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Nuno Lunet, Per Lytsy, Guansheng Ma, Jun Ma, George LL Machado-Coelho, Suka Machi, Stefania Maggi, Dianna J Magliano, Marjeta Majer, Marcia Makdisse, Reza Malekzadeh, Rahul Malhotra, Kodavanti Mallikharjuna Rao, Sofia Malyutina, Yannis Manios, Jim I Mann, Enzo Manzato, Paula Margozzini, Pedro Marques-Vidal, Jaume Marrugat, Reynaldo Martorell, Ellisiv B Mathiesen, Alicia Matijasevich, Tandi E Matsha, Jean Claude N Mbanya, Anselmo J Mc Donald Posso, Shelly R McFarlane, Stephen T McGarvey, Stela McLachlan, Rachael M McLean, Breige A McNulty, Amir Sharifuddin Md Khir, Sounnia Mediene-Benchekor, Jurate Medzioniene, Aline Meirhaeghe, Christa Meisinger, Ana Maria B Menezes, Geetha R Menon, Indrapal I Meshram, Andres Metspalu, Jie Mi, Kairit Mikkel, Jody C Miller, Juan Francisco Miquel, J Jaime Miranda, Marjeta Misigoj-Durakovic, Mostafa K Mohamed, Kazem Mohammad, Noushin Mohammadifard, Viswanathan Mohan, Muhammad Fadhli Mohd Yusoff, Niels C Moller, Denes Molnar, Amirabbas Momenan, Charles K Mondo, Kotsedi Daniel K Monyeki, Leila B Moreira, Alain Morejon, Luis A Moreno, Karen Morgan, George Moschonis, Malgorzata Mossakowska, Aya Mostafa, Jorge Mota, Mohammad Esmaeel Motlagh, Jorge Motta, Maria L Muiesan, Martina Mueller-Nurasyid, Neil Murphy, Jaakko Mursu, Vera Musil, Gabriele Nagel, Balkish M Naidu, Harunobu Nakamura, Jana Namsna, Ei Ei K Nang, Vinay B Nangia, Sameer Narake, Eva Maria Navarrete-Munoz, Ndeye Coumba Ndiaye, William A Neal, Ilona Nenko, Flavio Nervi, Hannelore K Neuhauser, Nguyen D Nguyen, Quang Ngoc Nguyen, Ramfis E Nieto-Martinez, Teemu J Niiranen, Guang Ning, Toshiharu Ninomiya, Sania Nishtar, Marianna Noale, Oscar A Noboa, Ahmad Ali Noorbala, Teresa Norat, Davide Noto, Mohannad Al Nsour, Dermot O’Reilly, Kyungwon Oh, Maria Teresa A. Olinto, Isabel O Oliveira, Mohd Azahadi Omar, Altan Onat, Pedro Ordunez, Clive Osmond, Sergej M Ostojic, Johanna A Otero, Kim Overvad, Ellis Owusu-Dabo, Fred Michel Paccaud, Cristina Padez, Elena Pahomova, Andrzej Pajak, Domenico Palli, Luigi Palmieri, Songhomitra Panda-Jonas, Francesco Panza, Dimitrios Papandreou, Winsome R Parnell, Mahboubeh Parsaeian, Ivan Pecin, Mangesh S Pednekar, Nasheeta Peer, Petra H Peeters, Sergio Viana Peixoto, Catherine Pelletier, Markku Peltonen, Alexandre C Pereira, Rosa Marina Perez, Annette Peters, Janina Petkeviciene, Niloofar Peykari, Son Thai Pham, Iris Pigeot, Hynek Pikhart, Aida Pilav, Lorenza Pilotto, Freda Pitakaka, Pedro Plans-Rubio, Maria Polakowska, Ozren Polasek, Miquel Porta, Marileen LP Portegies, Akram Pourshams, Rajendra Pradeepa, Mathur Prashant, Jacqueline F. Price, Maria Puiu, Margus Punab, Radwan F Qasrawi, Mostafa Qorbani, Ivana Radic, Ricardas Radisauskas, Mahfuzar Rahman, Olli Raitakari, Manu Raj, Sudha Ramachandra Rao, Elisabete Ramos, Sanjay Rampal, Daniel A Rangel Reina, Finn Rasmussen, Josep Redon, Paul Ferdinand M. Reganit, Robespierre Ribeiro, Elio Riboli, Fernando Rigo, Tobias F Rinke de Wit, Raphael M Ritti-Dias, Sian M Robinson, Cynthia Robitaille, Fernando Rodriguez-Artalejo, Laura A Rodriguez-Villamizar, Rosalba Rojas-Martinez, Annika Rosengren, Adolfo Rubinstein, Ornelas Rui, Blanca Sandra Ruiz-Betancourt, Andrea RV Russo Horimoto, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S Sachdev, Olfa Saidi, Sibel Sakarya, Benoit Salanave, Eduardo Salazar Martinez, Diego Salmeron, Veikko Salomaa, Jukka T Salonen, Massimo Salvetti, Jose Sanchez-Abanto, Susana Sans, Diana Santos, Ina S Santos, Renata Nunes dos Santos, Rute Santos, Jouko L Saramies, Luis B Sardinha, Giselle Sarganas Margolis, Nizal Sarrafzadegan, Kai-Uwe Saum, Savvas C Savva, Marcia Scazufca, Herman Schargrodsky, Ione J Schneider, Constance Schultsz, Aletta E Schutte, Abhijit Sen, Idowu O Senbanjo, Sadaf G Sepanlou, Sanjib K Sharma, Jonathan E Shaw, Kenji Shibuya, Dong Wook Shin, Youchan Shin, Rosalynn Siantar, Abla M Sibai, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A Simons, Michael Sjotrom, Sine Skovbjerg, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Margaret C Smith, Marieke B Snijder, Hung-Kwan So, Eugene Sobngwi, Stefan Soderberg, Vincenzo Solfrizzi, Emily Sonestedt, Yi Song, Thorkild IA Sorensen, Maroje Soric, Charles Sossa Jerome, Aicha Soumare, Jan A Staessen, Gregor Starc, Maria G Stathopoulou, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D Stein, George S Stergiou, Jochanan Stessman, Jutta Stieber, Doris Stoeckl, Tanja Stocks, Jakub Stokwiszewski, Karien Stronks, Maria Wany Strufaldi, Chien-An Sun, Johan Sundstrom, Yn-Tz Sung, Paibul Suriyawongpaisal, Rody G Sy, E Shyong Tai, Mari-Liis Tammesoo, Abdonas Tamosiunas, Line Tang, Xun Tang, Frank Tanser, Yong Tao, Mohammed Rasoul Tarawneh, Carolina B Tarqui-Mamani, Anne Taylor, Holger Theobald, Lutgarde Thijs, Betina H Thuesen, Anne Tjonneland, Hanna K Tolonen, Murat Topbas, Roman Topor-Madry, Maria Jose Tormo, Maties Torrent, Pierre Traissac, Dimitrios Trichopoulos, Antonia Trichopoulou, Oanh TH Trinh, Atul Trivedi, Lechaba Tshepo, Marshall K Tulloch-Reid, Tomi-Pekka Tuomainen, Maria L Turley, Per Tynelius, Christophe Tzourio, Peter Ueda, Eunice Ugel, Hanno Ulmer, Hannu MT Uusitalo, Gonzalo Valdivia, Damaskini Valvi, Yvonne T van der Schouw, Koen Van Herck, Lenie van Rossem, Irene GM van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Lars Vatten, Tomas Vega, Gustavo Velasquez-Melendez, Giovanni Veronesi, WM Monique Verschuren, Roosmarijn Verstraeten, Cesar G Victora, Lucie Viet, Eira Viikari-Juntura, Paolo Vineis, Jesus Vioque, Jyrki K Virtanen, Sophie Visvikis-Siest, Bharathi Viswanathan, Peter Vollenweider, Ana Vrdoljak, Martine Vrijheid, Alisha N Wade, Aline Wagner, Janette Walton, Wan Nazaimoon Wan Mohamud, Ming-Dong Wang, Qian Wang, Ya Xing Wang, S Goya Wannamethee, Nicholas Wareham, Niels Wederkopp, Deepa Weerasekera, Peter H Whincup, Kurt Widhalm, Indah S Widyahening, Andrzej Wiecek, Alet H Wijga, Rainford J Wilks, Peter Willeit, Emmanuel A. Williams, Tom Wilsgaard, Bogdan Wojtyniak, Tien Yin Wong, Roy A Wong-McClure, Jean Woo, Mark Woodward, Aleksander Giwercman Wu, Frederick C Wu, Shou Ling Wu, Haiquan Xu, Weili Yan, Xiaoguang Yang, Xingwang Ye, Panayiotis K Yiallouros, Akihiro Yoshihara, Novie O Younger-Coleman, Ahmad F Yusoff, Sabina Zambon, Tomasz Zdrojewski, Yi Zeng, Dong Zhao, Wenhua Zhao, Yingffeng Zheng, Dan Zhu, Esther Zimmermann, and Julio Zuniga Cisneros. 2017. “Worldwide Trends in Blood Pressure from 1975 to 2015 : A Pooled Analysis of 1479 Population-Based Measurement Studies with 19.1 Million Participants.” LANCET 389 (10064): 37–55. doi:10.1016/S0140-6736(16)31919-5.
Vancouver
1.
Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ, et al. Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. LANCET. 2017;389(10064):37–55.
IEEE
[1]
B. Zhou et al., “Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants,” LANCET, vol. 389, no. 10064, pp. 37–55, 2017.
@article{8508459,
  abstract     = {{Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. 
Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. 
Findings: We pooled 1479 studies that had measured the blood pressures of 19.1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127.0 mm Hg (95% credible interval 125.7-128.3) in men and 122.3 mm Hg (121.0-123.6) in women; age-standardised mean diastolic blood pressure was 78.7 mm Hg (77.9-79.5) for men and 76.7 mm Hg (75.9-77.6) for women. Global age-standardised prevalence of raised blood pressure was 24.1% (21.4-27.1) in men and 20.1% (17.8-22.5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. 
Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.}},
  author       = {{Zhou, Bin and Bentham, James and Di Cesare, Mariachiara and Bixby, Honor and Danaei, Goodarz and Cowan, Melanie J and Paciorek, Christopher J and Singh, Gitanjali and Hajifathalian, Kaveh and Bennett, James E and Taddei, Cristina and Bilano, Ver and Carrillo-Larco, Rodrigo M and Djalalinia, Shirin and Khatibzadeh, Shahab and Lugero, Charles and Peykari, Niloofar and Zhang, Wan Zhu and Lu, Yuan and Stevens, Gretchen A and Riley, Leanne M and Bovet, Pascal and Elliott, Paul and Gu, Dongfeng and Ikeda, Nayu and Jackson, Rod T and Joffres, Michel and Kengne, Andre Pascal and Laatikainen, Tiina and Lam, Tai Hing and Laxmaiah, Avula and Liu, Jing and Miranda, J Jaime and Mondo, Charles K and Neuhauser, Hannelore K and Sundstrom, Johan and Smeeth, Liam and Soric, Maroje and Woodward, Mark and Ezzati, Majid and Abarca-Gomez, Leandra and Abdeen, Ziad A and Rahim, Hanan Abdul and Abu-Rmeileh, Niveen M and Acosta-Cazares, Benjamin and Adams, Robert and Aekplakorn, Wichai and Afsana, Kaosar and Aguilar-Salinas, Carlos A and Agyemang, Charles and Ahmadvand, Alireza and Ahrens, Wolfgang and Al Raddadi, Rajaa and Al Woyatan, Rihab and Ali, Mohamed M and Alkerwi, Ala'a and Aly, Eman and Amouyel, Philippe and Amuzu, Antoinette and Andersen, Lars Bo and Anderssen, Sigmund A and Angquist, Lars and Anjana, Ranjit Mohan and Ansong, Daniel and Aounallah-Skhiri, Hajer and Araujo, Joana and Ariansen, Inger and Aris, Tahir and Arlappa, Nimmathota and Aryal, Krishna and Arveiler, Dominique and Assah, Felix K and Assuncao, Maria Cecilia F and Avdicova, Maria and Azevedo, Ana and Azizi, Fereidoun and Babu, Bontha V and Bahijri, Suhad and Balakrishna, Nagalla and Bandosz, Piotr and Banegas, Jose R and Barbagallo, Carlo M and Barcelo, Alberto and Barkat, Amina and Barros, Aluisio JD and Barros, Mauro V and Bata, Iqbal and Batieha, Anwar M and Baur, Louise A and Beaglehole, Robert and Ben Romdhane, Habiba and Benet, Mikhail and Benson, Lowell S and Bernabe-Ortiz, Antonio and Bernotiene, Gailute and Bettiol, Heloisa and Bhagyalaxmi, Aroor and Bharadwaj, Sumit and Bhargava, Santosh K and Bi, Yufang and Bikbov, Mukharram and Bjerregaard, Peter and Bjertness, Espen and Bjokelund, Cecilia and Blokstra, Anneke and Bo, Simona and Bobak, Martin and Boeing, Heiner and Boggia, Jose G and Boissonnet, Carlos P and Bongard, Vanina and Bovet, Pascal and Braeckman, Lutgart and Brajkovich, Imperia and Branca, Francesco and Breckenkamp, Juergen and Brenner, Hermann and Brewster, Lizzy M and Bruno, Graziella and Bueno-de-Mesquita, HB (as) and Bugge, Anna and Burns, Con and Bursztyn, Michael and de Leon, Antonio Cabrera and Cameron, Christine and Can, Gunay and Candido, Ana Paula C and Capuano, Vincenzo and Cardoso, Viviane C and Carlsson, Axel C and Carvalho, Maria J and Casanueva, Felipe F and Casanueva, Felipe F and Casas, Juan-Pablo and Caserta, Carmelo A and Chamukuttan, Snehalatha and Chan, Angelique W and Chan, Queenie and Chaturvedi, Himanshu K and Chaturvedi, Nishi and Chen, Chien-Jen and Chen, Fangfang and Chen, Huashuai and Chen, Shuohua and Chen, Zhengming and Cheng, Ching-Yu and Dekkaki, Imane Cherkaoui and Chetrit, Angela and Chiolero, Arnaud and Chiou, Shu-Ti and Chirita-Emandi, Adela and Cho, Belong and Cho, Yumi and Chudek, Jerzy and Cifkova, Renata and Claessens, Frank and Clays, Els and Concin, Hans and Cooper, Cyrus and Cooper, Rachel and Coppinger, Tara C and Costanzo, Simona and Cottel, Dominique and Cowell, Chris and Craig, Cora L and Crujeiras, Ana B and Cruz, Juan J and D'Arrigo, Graziella and d'Orsi, Eleonora and Dallongeville, Jean and Damasceno, Albertino and Danaei, Goodarz and Dankner, Rachel and Dantoft, Thomas M and Dauchet, Luc and De Backer, Gui and De Bacquer, Dirk and de Gaetano, Giovanni and De Henauw, Stefaan and De Smedt, Delphine and Deepa, Mohan and Dehghan, Abbas and Delisle, Helene and Deschamps, Valerie and Dhana, Klodian and Di Castelnuovo, Augusto F and Dias-da-Costa, Juvenal Soares and Diaz, Alejandro and Dickerson, Ty T and Djalalinia, Shirin and Do, Ha TP and Dobson, Annette J and Donfrancesco, Chiara and Donoso, Silvana P and Doering, Angela and Doua, Kouamelan and Drygas, Wojciech and Dulskiene, Virginija and Dzakula, Aleksandar and Dzerve, Vilnis and Dziankowska-Zaborszczyk, Elzbieta and Eggertsen, Robert and Ekelund, Ulf and El Ati, Jalila and Ellert, Ute and Elliott, Paul and Elosua, Roberto and Erasmus, Rajiv T and Erem, Cihangir and Eriksen, Louise and Escobedo-de la Pena, Jorge and Evans, Alun and Faeh, David and Fall, Caroline H and Farzadfar, Farshad and Felix-Redondo, Francisco J and Ferguson, Trevor S and Fernandez-Berges, Daniel and Ferrante, Daniel and Ferrari, Marika and Ferreccio, Catterina and Ferrieres, Jean and Finn, Joseph D and Fischer, Krista and Foeger, Bernhard and Foo, Leng Huat and Forslund, Ann-Sofie and Forsner, Maria and Fortmann, Stephen P and Fouad, Heba M and Francis, Damian K and Franco, Maria do Carmo and Franco, Oscar H and Frontera, Guillermo and Fuchs, Flavio D and Fuchs, Sandra C and Fujita, Yuki and Furusawa, Takuro and Gaciong, Zbigniew and Gareta, Dickman and Garnett, Sarah P and Gaspoz, Jean-Michel and Gasull, Magda and Gates, Louise and Gavrila, Diana and Geleijnse, Johanna M and Ghasemian, Anoosheh and Ghimire, Anup and Giampaoli, Simona and Gianfagna, Francesco and Giovannelli, Jonathan and Goldsmith, Rebecca A and Goncalves, Helen and Gonzalez Gross, Marcela and Gonzalez Rivas, Juan P and Gottrand, Frederic and Graff-Iversen, Sidsel and Grafnetter, Dusan and Grajda, Aneta and Gregor, Ronald D and Grodzicki, Tomasz and Grontved, Anders and Gruden, Grabriella and Grujic, Vera and Gu, Dongfeng and Guan, Ong Peng and Gudnason, Vilmundur and Guerrero, Ramiro and Guessous, Idris and Guimaraes, Andre L and Gulliford, Martin C and Gunnlaugsdottir, Johanna and Gunter, Marc and Gupta, Prakash C and Gureje, Oye and Gurzkowska, Beata and Gutierrez, Laura and Gutzwiller, Felix and Hadaegh, Farzad and Halkjaer, Jytte and Hambleton, Ian R and Hardy, Rebecca and Harikumar, Rachakulla and Hata, Jun and Hayes, Alison J and He, Jiang and Hendriks, Marleen Elisabeth and Henriques, Ana and Hernandez Cadena, Leticia and Herqutanto, Herqutanto and Herrala, Sauli and Heshmat, Ramin and Hihtaniemi, Ilpo Tapani and Ho, Sai Yin and Ho, Suzanne C and Hobbs, Michael and Hofman, Albert and Dinc, Gonul Horasan and Hormiga, Claudia M and Horta, Bernardo L and Houti, Leila and Howitt, Christina and Htay, Thein Thein and Htet, Aung Soe and Hu, Yonghua and Maria Huerta, Jose and Husseini, Abdullatif S and Huybrechts, Inge and Hwalla, Nahla and Iacoviello, Licia and Iannone, Anna G and Ibrahim, M Mohsen and Ikram, M Arfan and Irazola, Vilma E and Islam, Muhammad and Ivkovic, Vanja and Iwasaki, Masanori and Jackson, Rod T and Jacobs, Jeremy M and Jafar, Tazeen and Jamrozik, Konrad and Janszky, Imre and Jasienska, Grazyna and Jelakovic, Bojan and Jiang, Chao Qiang and Johansson, Mattias and Jonas, Jost B and Jorgensen, Torben and Joshi, Pradeep and Juolevi, Anne and Jurak, Gregor and Juresa, Vesna and Kaaks, Rudolf and Kafatos, Anthony and Kalter-Leibovici, Ofra and Kamaruddin, Nor Azmi and Kasaeian, Amir and Katz, Joanne and Kauhanen, Jussi and Kaur, Prabhdeep and Kavousi, Maryam and Kazakbaeva, Gyulli and Keil, Ulrich and Boker, Lital Keinan and Keinanen-Kiukaanniemi, Sirkka and Kelishadi, Roya and Kemper, Han CG and Kengne, Andre Pascal and Kersting, Mathilde and Key, Timothy and Khader, Yousef Saleh and Khalili, Davood and Khang, Young-Ho and Khaw, Kay-Tee and Kiechl, Stefan and Killewo, Japhet and Kim, Jeongseon and Klumbiene, Jurate and Kolle, Elin and Kolsteren, Patrick and Korrovits, Paul and Koskinen, Seppo and Kouda, Katsuyasu and Koziel, Slawomir and Kristensen, Peter Lund and Krokstad, Steinar and Kromhout, Daan and Kruger, Herculina S and Kubinova, Ruzena and Kuciene, Renata and Kuh, Diana and Kujala, Urho M and Kula, Krzysztof and Kulaga, Zbigniew and Kumar, R Krishna and Kurjata, Pawel and Kusuma, Yadlapalli S and Kuulasmaa, Kari and Kyobutungi, Catherine and Laatikainen, Tiina and Lachat, Carl and Landrove, Orlando and Lanska, Vera and Lappas, Georg and Larijani, Bagher and Laugsand, Lars E and Laxmaiah, Avula and Bao, Khanh Le Nguyen and Le, Tuyen D and Leclercq, Catherine and Lee, Jeannette and Lee, Jeonghee and Lehtimaki, Terho and Lekhraj, Rampal and Leon-Munoz, Luz M and Levitt, Naomi S and Li, Yanping and Lilly, Christa L and Lim, Wei-Yen and Fernanda Lima-Costa, M and Lin, Hsien-Ho and Lin, Xu and Linneberg, Allan and Lissner, Lauren and Litwin, Mieczyslaw and Liu, Jing and Lorbeer, Roberto and Lotufo, Paulo A and Eugenio Lozano, Jose and Luksiene, Dalia and Lundqvist, Annamari and Lunet, Nuno and Lytsy, Per and Ma, Guansheng and Ma, Jun and Machado-Coelho, George LL and Machi, Suka and Maggi, Stefania and Magliano, Dianna J and Majer, Marjeta and Makdisse, Marcia and Malekzadeh, Reza and Malhotra, Rahul and Rao, Kodavanti Mallikharjuna and Malyutina, Sofia and Manios, Yannis and Mann, Jim I and Manzato, Enzo and Margozzini, Paula and Marques-Vidal, Pedro and Marrugat, Jaume and Martorell, Reynaldo and Mathiesen, Ellisiv B and Matijasevich, Alicia and Matsha, Tandi E and Mbanya, Jean Claude N and Posso, Anselmo J Mc Donald and McFarlane, Shelly R and McGarvey, Stephen T and McLachlan, Stela and McLean, Rachael M and McNulty, Breige A and Khir, Amir Sharifuddin Md and Mediene-Benchekor, Sounnia and Medzioniene, Jurate and Meirhaeghe, Aline and Meisinger, Christa and Menezes, Ana Maria B and Menon, Geetha R and Meshram, Indrapal I and Metspalu, Andres and Mi, Jie and Mikkel, Kairit and Miller, Jody C and Francisco Miquel, Juan and Jaime Miranda, J and Misigoj-Durakovic, Marjeta and Mohamed, Mostafa K and Mohammad, Kazem and Mohammadifard, Noushin and Mohan, Viswanathan and Yusoff, Muhammad Fadhli Mohd and Moller, Niels C and Molnar, Denes and Momenan, Amirabbas and Mondo, Charles K and Monyeki, Kotsedi Daniel K and Moreira, Leila B and Morejon, Alain and Moreno, Luis A and Morgan, Karen and Moschonis, George and Mossakowska, Malgorzata and Mostafa, Aya and Mota, Jorge and Motlagh, Mohammad Esmaeel and Motta, Jorge and Muiesan, Maria L and Mueller-Nurasyid, Martina and Murphy, Neil and Mursu, Jaakko and Musil, Vera and Nagel, Gabriele and Naidu, Balkish M and Nakamura, Harunobu and Namsna, Jana and Nang, Ei Ei K and Nangia, Vinay B and Narake, Sameer and Maria Navarrete-Munoz, Eva and Ndiaye, Ndeye Coumba and Neal, William A and Nenko, Ilona and Nervi, Flavio and Neuhauser, Hannelore K and Nguyen, Nguyen D and Nguyen, Quang Ngoc and Nieto-Martinez, Ramfis E and Niiranen, Teemu J and Ning, Guang and Ninomiya, Toshiharu and Nishtar, Sania and Noale, Marianna and Noboa, Oscar A and Noorbala, Ahmad Ali and Norat, Teresa and Noto, Davide and Al Nsour, Mohannad and O'Reilly, Dermot and Oh, Kyungwon and Olinto, Maria Teresa A. and Oliveira, Isabel O and Omar, Mohd Azahadi and Onat, Altan and Ordunez, Pedro and Osmond, Clive and Ostojic, Sergej M and Otero, Johanna A and Overvad, Kim and Owusu-Dabo, Ellis and Paccaud, Fred Michel and Padez, Cristina and Pahomova, Elena and Pajak, Andrzej and Palli, Domenico and Palmieri, Luigi and Panda-Jonas, Songhomitra and Panza, Francesco and Papandreou, Dimitrios and Parnell, Winsome R and Parsaeian, Mahboubeh and Pecin, Ivan and Pednekar, Mangesh S and Peer, Nasheeta and Peeters, Petra H and Peixoto, Sergio Viana and Pelletier, Catherine and Peltonen, Markku and Pereira, Alexandre C and Marina Perez, Rosa and Peters, Annette and Petkeviciene, Janina and Peykari, Niloofar and Pham, Son Thai and Pigeot, Iris and Pikhart, Hynek and Pilav, Aida and Pilotto, Lorenza and Pitakaka, Freda and Plans-Rubio, Pedro and Polakowska, Maria and Polasek, Ozren and Porta, Miquel and Portegies, Marileen LP and Pourshams, Akram and Pradeepa, Rajendra and Prashant, Mathur and Price, Jacqueline F. and Puiu, Maria and Punab, Margus and Qasrawi, Radwan F and Qorbani, Mostafa and Radic, Ivana and Radisauskas, Ricardas and Rahman, Mahfuzar and Raitakari, Olli and Raj, Manu and Rao, Sudha Ramachandra and Ramos, Elisabete and Rampal, Sanjay and Rangel Reina, Daniel A and Rasmussen, Finn and Redon, Josep and Reganit, Paul Ferdinand M. and Ribeiro, Robespierre and Riboli, Elio and Rigo, Fernando and de Wit, Tobias F Rinke and Ritti-Dias, Raphael M and Robinson, Sian M and Robitaille, Cynthia and Rodriguez-Artalejo, Fernando and Rodriguez-Villamizar, Laura A and Rojas-Martinez, Rosalba and Rosengren, Annika and Rubinstein, Adolfo and Rui, Ornelas and Sandra Ruiz-Betancourt, Blanca and Russo Horimoto, Andrea RV and Rutkowski, Marcin and Sabanayagam, Charumathi and Sachdev, Harshpal S and Saidi, Olfa and Sakarya, Sibel and Salanave, Benoit and Salazar Martinez, Eduardo and Salmeron, Diego and Salomaa, Veikko and Salonen, Jukka T and Salvetti, Massimo and Sanchez-Abanto, Jose and Sans, Susana and Santos, Diana and Santos, Ina S and dos Santos, Renata Nunes and Santos, Rute and Saramies, Jouko L and Sardinha, Luis B and Margolis, Giselle Sarganas and Sarrafzadegan, Nizal and Saum, Kai-Uwe and Savva, Savvas C and Scazufca, Marcia and Schargrodsky, Herman and Schneider, Ione J and Schultsz, Constance and Schutte, Aletta E and Sen, Abhijit and Senbanjo, Idowu O and Sepanlou, Sadaf G and Sharma, Sanjib K and Shaw, Jonathan E and Shibuya, Kenji and Shin, Dong Wook and Shin, Youchan and Siantar, Rosalynn and Sibai, Abla M and Santos Silva, Diego Augusto and Simon, Mary and Simons, Judith and Simons, Leon A and Sjotrom, Michael and Skovbjerg, Sine and Slowikowska-Hilczer, Jolanta and Slusarczyk, Przemyslaw and Smeeth, Liam and Smith, Margaret C and Snijder, Marieke B and So, Hung-Kwan and Sobngwi, Eugene and Soderberg, Stefan and Solfrizzi, Vincenzo and Sonestedt, Emily and Song, Yi and Sorensen, Thorkild IA and Soric, Maroje and Jerome, Charles Sossa and Soumare, Aicha and Staessen, Jan A and Starc, Gregor and Stathopoulou, Maria G and Stavreski, Bill and Steene-Johannessen, Jostein and Stehle, Peter and Stein, Aryeh D and Stergiou, George S and Stessman, Jochanan and Stieber, Jutta and Stoeckl, Doris and Stocks, Tanja and Stokwiszewski, Jakub and Stronks, Karien and Strufaldi, Maria Wany and Sun, Chien-An and Sundstrom, Johan and Sung, Yn-Tz and Suriyawongpaisal, Paibul and Sy, Rody G and Tai, E Shyong and Tammesoo, Mari-Liis and Tamosiunas, Abdonas and Tang, Line and Tang, Xun and Tanser, Frank and Tao, Yong and Tarawneh, Mohammed Rasoul and Tarqui-Mamani, Carolina B and Taylor, Anne and Theobald, Holger and Thijs, Lutgarde and Thuesen, Betina H and Tjonneland, Anne and Tolonen, Hanna K and Topbas, Murat and Topor-Madry, Roman and Jose Tormo, Maria and Torrent, Maties and Traissac, Pierre and Trichopoulos, Dimitrios and Trichopoulou, Antonia and Trinh, Oanh TH and Trivedi, Atul and Tshepo, Lechaba and Tulloch-Reid, Marshall K and Tuomainen, Tomi-Pekka and Turley, Maria L and Tynelius, Per and Tzourio, Christophe and Ueda, Peter and Ugel, Eunice and Ulmer, Hanno and Uusitalo, Hannu MT and Valdivia, Gonzalo and Valvi, Damaskini and van der Schouw, Yvonne T and Van Herck, Koen and van Rossem, Lenie and van Valkengoed, Irene GM and Vanderschueren, Dirk and Vanuzzo, Diego and Vatten, Lars and Vega, Tomas and Velasquez-Melendez, Gustavo and Veronesi, Giovanni and Verschuren, WM Monique and Verstraeten, Roosmarijn and Victora, Cesar G and Viet, Lucie and Viikari-Juntura, Eira and Vineis, Paolo and Vioque, Jesus and Virtanen, Jyrki K and Visvikis-Siest, Sophie and Viswanathan, Bharathi and Vollenweider, Peter and Vrdoljak, Ana and Vrijheid, Martine and Wade, Alisha N and Wagner, Aline and Walton, Janette and Mohamud, Wan Nazaimoon Wan and Wang, Ming-Dong and Wang, Qian and Wang, Ya Xing and Wannamethee, S Goya and Wareham, Nicholas and Wederkopp, Niels and Weerasekera, Deepa and Whincup, Peter H and Widhalm, Kurt and Widyahening, Indah S and Wiecek, Andrzej and Wijga, Alet H and Wilks, Rainford J and Willeit, Peter and Williams, Emmanuel A. and Wilsgaard, Tom and Wojtyniak, Bogdan and Wong, Tien Yin and Wong-McClure, Roy A and Woo, Jean and Woodward, Mark and Wu, Aleksander Giwercman and Wu, Frederick C and Wu, Shou Ling and Xu, Haiquan and Yan, Weili and Yang, Xiaoguang and Ye, Xingwang and Yiallouros, Panayiotis K and Yoshihara, Akihiro and Younger-Coleman, Novie O and Yusoff, Ahmad F and Zambon, Sabina and Zdrojewski, Tomasz and Zeng, Yi and Zhao, Dong and Zhao, Wenhua and Zheng, Yingffeng and Zhu, Dan and Zimmermann, Esther and Zuniga Cisneros, Julio}},
  issn         = {{0140-6736}},
  journal      = {{LANCET}},
  keywords     = {{CARDIOVASCULAR RISK-FACTORS,HEALTH EXAMINATION SURVEYS,HYPERTENSION,PREVALENCE,UNITED-STATES,SYSTEMATIC ANALYSIS,GENDER-DIFFERENCES,INCOME COUNTRIES,SECULAR TRENDS,MONICA PROJECT,GLOBAL BURDEN}},
  language     = {{eng}},
  number       = {{10064}},
  pages        = {{37--55}},
  title        = {{Worldwide trends in blood pressure from 1975 to 2015 : a pooled analysis of 1479 population-based measurement studies with 19.1 million participants}},
  url          = {{http://doi.org/10.1016/S0140-6736(16)31919-5}},
  volume       = {{389}},
  year         = {{2017}},
}

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