- Elevated systolic (SBP) and diastolic (DBP) blood pressure both contribute independently to cardiovascular disease (CVD) risk, although SBP has a greater effect.
Why this matters
- Conflicting hypertension thresholds and evidence base do not help resolve the question of whether SBP or DBP elevations matter most for CVD risk.
- In this study, the effects of both are present with the lower 2017 hypertension threshold of ≥130/80 mmHg and with the ≥140/90 mmHg threshold, supporting the proposed benefits of the 2017 guidelines change.
- SBP and DBP (mmHg) hypertension independently predict adverse cardiovascular outcomes (adjusted HRs per unit z-score increase; 95% CIs):
- SBP ≥140: 1.18 (1.17-1.18);
- SBP ≥130: 1.18 (1.17-1.19);
- DBP ≥90: 1.06 (1.06-1.07); and
- DBP ≥80: 1.08 (1.06-1.09).
- Increasing quantiles of SBP correlated with increased adverse outcome risks.
- DBP showed a J-shaped curve, with highest risk for myocardial infarction or stroke in the lowest and highest deciles.
- Isolated SBP and isolated DBP were also linked to increased CVD events.
- Data from outpatient population of 1,316,363 adults with 36,784,850 BP measurements.
- Primary composite outcome: first episode of myocardial infarction, stroke (ischemic/hemorrhagic).
- Funding: Kaiser Permanente Northern California Community Benefit Program.
- Retrospective study of prospectively built databases.
- BP measures during routine visits.
- Diet modifications not known.