Population-level mortality benefits of improved blood pressure control in Indonesia: a modelling study

Background: There are few estimates of the potential gains in adult mortality from population-level improvements in systolic blood pressure (SBP) in a major low-and-middle income country (LMIC). Using nationally representative cohort data from Indonesia-the third most populous LMIC- I estimated the gains in adult life expectancy from improving SBP control among adults ages 40 and above and assessed the benefits among richer and poorer subpopulations. Methods: I used longitudinal data from 10085 adults ages 40 and above (75288 person-age observations) enrolled in the 2007 and 2014/15 waves of the Indonesian Family Life Survey. Next, I used Poisson-regression parametric g-formulas to directly estimate age-specific mortality rates under different blood pressure control strategies and constructed period life expectancies using the observed and counterfactual mortality rates. Results: Fully controlling SBP to a population mean of under 125mmHg was associated with a life expectancy gain at age 40 of 5.3years [95% confidence interval (CI): 3.2, 7.4] for men and 6.0years (95% CI: 3.6, 8.4) for women. The gains associated with blood pressure control were similar for both rich and poor subpopulations. The life expectancy gains under scenarios with imperfect blood pressure control and coverage were more modest in size and ranged between 1 and 2.5years for a large fraction of the scenarios. Conclusions: In Indonesia, elevated SBP carries a large mortality burden, though the results suggest that realistic efforts to address hypertension will likely produce more modest gains in life expectancy. Comparing improvements from different strategies and identifying the most cost-effective ways to introduce and scale up hypertension interventions is a critical focus for both research and policy.