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

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 (probit-transformed) 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 high-income 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

Public Health Emergency Preparedness and Response by Regulatory Authorities in South Korea, United States, and Europe

Since the outbreak of the new strain of coronavirus (SARS-CoV-2, COVID-19) was first reported, regulatory authorities worldwide have issued various regulatory guidelines and recommendations. Global authorities are committed to supporting developers of potential vaccines and treatments for COVID-19. This study reviewed the guidelines and regulatory procedures instituted by authorities in the United States and Europe to understand the current perspectives of regulatory agencies worldwide and derive implications for public health emergency responses. The Act on Encouragement of Development and Emergency Circulation of Medical Countermeasures for public health emergencies enacted in 2021 established the Ministry of Food and Drug Safety (MFDS) to oversee policies for public health emergencies. In the US, the Public Law 113-5, the PHS Act, the PREP Act and the FD&amp;C Act grant authorities emergency use power with respect to medical countermeasures needed during public health emergencies. The FDA can also facilitate the use of those medical countermeasures. The EMA has accelerated regulatory procedures in place for expediting the development and approval of medicinal products for COVID-19. The EMA’s rapid procedure includes rolling review, accelerated assessment and conditional marketing authorisation. Based on the review of foreign policies and practices regarding public health emergencies, this study showed that the Act on Encouragement of Development and Emergency Circulation of Medical Countermeasures for public health emergency responses has made important advances in public health emergency preparedness and response.</jats:p