Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Effect of use and management systems on the physical and hydraulic properties of a yellow argisol of coastal tablelands

Os diferentes sistemas de manejo com cana-de-açúcar em solos de tabuleiros costeiros podem causar alterações na estrutura original do solo. Os efeitos de diferentes sistemas de manejo com cana-de-açúcar nas propriedades físico-hídricas de um Argissolo Amarelo coeso foram estudados em quatro áreas selecionadas na usina Triunfo, no Estado de Alagoas. Os tratamentos consistiram de uma área não irrigada, uma área irrigada, uma com aplicação de vinhaça e uma sob floresta nativa como condição original. As amostras foram retiradas das profundidades de 0–0,2, 0,2–0,4 e 0,4–0,8 m, para determinar as alterações na densidade do solo, distribuição de diâmetro dos poros, curvas de retenção de água no solo e condutividade hidráulica saturada. O maior grau de dispersão de argila nos solos cultivados com cana-de-açúcar promoveu maior acúmulo desta partícula nas camadas subsuperficiais do solo. Os sistemas de manejo com canade- açúcar aumentaram a compactação do solo, com conseqüente redução da macroporosidade e condutividade hidráulica saturada, e aumento da retenção de água disponível do solo.Different sugarcane management systems on soils of coastal tablelands can cause alterations in their original soil structure. Effects of the different sugarcane management systems on the properties of a cohesive Yellow Argisol were studied in four areas of the Triunfo sugar mill in Alagoas State, Brazil. The treatments consisted of a site with and without cultivation irrigation each, one site with vinasse application and another under undisturbed native forest. Samples were collected at depths of 0–0.2, 0.2–0.4 and 0.4–0.8 m to determine the alterations in the bulk density, soil pore size distribution, soil water retention curves, and saturated hydraulic conductivity. The highest degree of clay dispersion in sugarcane-cultivated soils promoted a greater accumulation of clay particles in the subsurface soil layers. Management systems with sugarcane increased soil compaction, with a consequent alteration of the soil pore size distribution, reduced the saturated hydraulic conductivity and increased the retention of available water

Effect of use and management systems on the physical and hydraulic properties of a yellow argisol of coastal tablelands

Os diferentes sistemas de manejo com cana-de-açúcar em solos de tabuleiros costeiros podem causar alterações na estrutura original do solo. Os efeitos de diferentes sistemas de manejo com cana-de-açúcar nas propriedades físico-hídricas de um Argissolo Amarelo coeso foram estudados em quatro áreas selecionadas na usina Triunfo, no Estado de Alagoas. Os tratamentos consistiram de uma área não irrigada, uma área irrigada, uma com aplicação de vinhaça e uma sob floresta nativa como condição original. As amostras foram retiradas das profundidades de 0–0,2, 0,2–0,4 e 0,4–0,8 m, para determinar as alterações na densidade do solo, distribuição de diâmetro dos poros, curvas de retenção de água no solo e condutividade hidráulica saturada. O maior grau de dispersão de argila nos solos cultivados com cana-de-açúcar promoveu maior acúmulo desta partícula nas camadas subsuperficiais do solo. Os sistemas de manejo com canade- açúcar aumentaram a compactação do solo, com conseqüente redução da macroporosidade e condutividade hidráulica saturada, e aumento da retenção de água disponível do solo.Different sugarcane management systems on soils of coastal tablelands can cause alterations in their original soil structure. Effects of the different sugarcane management systems on the properties of a cohesive Yellow Argisol were studied in four areas of the Triunfo sugar mill in Alagoas State, Brazil. The treatments consisted of a site with and without cultivation irrigation each, one site with vinasse application and another under undisturbed native forest. Samples were collected at depths of 0–0.2, 0.2–0.4 and 0.4–0.8 m to determine the alterations in the bulk density, soil pore size distribution, soil water retention curves, and saturated hydraulic conductivity. The highest degree of clay dispersion in sugarcane-cultivated soils promoted a greater accumulation of clay particles in the subsurface soil layers. Management systems with sugarcane increased soil compaction, with a consequent alteration of the soil pore size distribution, reduced the saturated hydraulic conductivity and increased the retention of available water