Abstract

Raised blood pressure is a strong, heritable and modifiable risk factor for stroke and coronary artery disease, and is a leading cause of global morbidity and mortality. In most countries around the world, blood pressure rises with age such that at older ages (>60 years) 50% or more of the population has clinical hypertension, though a rise of blood pressure with age is not an inevitable consequence of ageing – there are remote populations around the world where blood pressure does not rise with age. While there have been favourable blood pressure trends in many countries over the past 40 years, trends have been increasing in some parts of the world including east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa.

Established risk factors for high blood pressure include sodium intake, body mass index and heavy alcohol drinking (positive) and potassium intake (inverse). Other dietary factors associated with high blood pressure, reported in the international INTERMAP study across four countries (China Japan, UK, USA ), include inverse associations with blood pressure of intakes of vegetable (plant) protein, polyunsaturated fatty acid (PUFA), phosphorus (P), Ca, Mg and non-heme iron (Fe). Taken together, more favourable levels of these factors are associated with systolic blood pressure lower by 10 mm Hg or more. Recently, GWAS studies have identified over 100 new variants independently associated with blood pressure, and other omic studies (e.g. metabolomics) are giving new insights into regulation of blood pressure and related metabolic conditions such as adiposity.