Impact of Hypertension Prevalence Trend on Mortality and Burdens of Dementia and Disability in England and Wales to 2060: Modelling Study

摘要: Background: Previous estimates of the impact of public health interventions targeting hypertension on burden of disease and mortality have not considered the effects of hypertension reduction on mortality, dementia and disability simultaneously.Methods: We modelled three plausible scenarios based on observed trends of hypertension prevalence 2003-2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases 50% by 2060. We used a probabilistic Markov Model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability and mortality to forecast their future occurrence in the England and Wales population. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios.Findings: If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 although the burdens of disability and dementia in absolute terms will change little. Alternatively, if the downward hypertension prevalence trend accelerates, by 50%, there would be a modest additional reduction in deaths, a small increase in dementia burden, no significant impact on disability burden, and+ 8% gain in healthy life expectancy at 65 from 2020 to 2060 (5· 3 vs. 4· 9 years) compared with the baseline scenario.Interpretation: The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on …