Blood Pressure, Systolic and Diastolic, and Cardiovascular Risks: US Population Data
Abstract
The National High Blood Pressure Education Program (NHBPEP) was launched 20 years ago based on data from population studies and clinical trials that showed high blood pressure (HBP) was a major unsolved—but soluble—mass public health problem. The present review summarizes recent data from US prospective population studies on blood pressure—systolic (SBP), diastolic (DBP)—and cardiovascular risk. The outcome variables include blood pressure-related risks, primarily incidence and mortality from coronary heart disease, stroke, other and all cardiovascular diseases (CVD); also cardiac abnormalites (roentgenographic, electrocardiographic, echocardiographic); also, all-cause mortality and life expectancy. Data accrued during the past 20 years confirm that SBP and DBP have continuous, graded, strong, independent, etiologically significant relationships to the outcome variables. These relationships are documented for young, middle-aged, and older men and for middle-aged and older women of varying socioeconomic backgrounds and ethnicity. Among persons aged 35 years or more, most have SBP/DBP above optimal (<120/<80 mm Hg); hence, they are at increased CVD risk, ie, the blood pressure problem involves most of the population, not only the substantial minority with clinical HBP. For middleaged and older persons, SBP relates even more strongly to risk than DBP; at every DBP level, higher SBP results in greater CVD risk and curtailment of life expectancy. A great potential exists for improved health and increased longevity through control of the blood pressure problem. Its realization requires a strategy combining populationwide and high-risk approaches, the former to prevent rise of blood pressure with age and to achieve primary prevention of HBP by nutritional-hygienic means; the latter to enhance detection, treatment, and control of HBP. The newly expanded goals of the NHBPEP, aimed at implementing this broader strategy for the solution of the blood pressure problem, merit active support from physicians and all health professionals. (Arch Intern Med. 1993;153:598-615)
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Data from more than 347,000 middle-aged men screened for MRFIT show a continuous, graded effect of blood pressure on the multivariable-adjusted relative risk for coronary heart disease mortality beginning at pressures well below 140 mm Hg.
“Data from more than 347,000 middle-aged men (35 to 57 years) screened for the Multiple Risk Factor Intervention Trial (MRFIT) provide precise estimates of incremental risks with higher BP levels.There is a continuous, graded effect of BP on the multivariableadjusted relative risk for CHD mortality beginning at pressures well below 140 mm Hg. 59,60”
Nearly two thirds of excess coronary heart disease deaths occurred in men with baseline systolic blood pressure between 130 and 159 mm Hg.
“Thus, nearly two thirds of excess CHD deaths occurred in men with baseline SBP between 130 and 159 mm Hg, relatively ''mild'' levels of elevated BP.”
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“[1] Stamler J, Stamler R, Neaton JD.”
BackgroundHemodialysis-associated hypertension: Pathophysiology and therapy
Hörl, M. P., & Hörl, W. H. (2002) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2002.30542 · Cited by 214 · see citing works
Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial
He, J., Gu, D., Wu, X., Chen, J., Duan, X., Chen, J., & Whelton, P. K. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-143-1-200507050-00004 · Cited by 212 · see citing works
Fornage, M., Amos, C. I., Kardia, S. R., Sing, C. F., Turner, S. T., & Boerwinkle, E. (1998) · Circulation · doi:10.1161/01.cir.97.18.1773 · Cited by 211 · see citing works
Papanikolaou, Y., & Fulgoni, V. L. I. (2008) · Journal of the American College of Nutrition · doi:10.1080/07315724.2008.10719740 · Cited by 211 · see citing works
“High blood pressure is a major independent risk factor for cardiovascular disease [1, 2].”
BackgroundHypertension Prevalence, Awareness, Treatment, and Control in Egypt
Ibrahim, M. M., Rizk, H., Appel, L. J., et al. (1995) · Hypertension · doi:10.1161/01.hyp.26.6.886 · Cited by 209 · see citing works
Wu, C.-Y., Hu, H.-Y., Chou, Y.-J., Huang, N., Chou, Y.-C., & Li, C.-P. (2015) · Medicine · doi:10.1097/md.0000000000002160 · Cited by 207 · see citing works
“INTRODUCTION H igh blood pressure (BP) is one of the most important risk factors for cardiovascular disease (CVD), which is the leading cause of mortality.(1,2) Approximately 54% of strokes and 47% of coronary heart diseases, worldwide, are attributable to high BP.”
BackgroundCircadian Misalignment Increases C-Reactive Protein and Blood Pressure in Chronic Shift Workers
Morris, C. J., Purvis, T. E., Mistretta, J., Hu, K., & Scheer, F. A. J. L. (2017) · Journal of Biological Rhythms · doi:10.1177/0748730417697537 · Cited by 209 · see citing works
“Thus, we tested the impact of circadian misalignment, similar to that experienced by real-life shift workers, on 24-h levels of hs-CRP and blood pressure, which are risk factors for cardiovascular disease (Stamler et al., 1993; Libby, 2006; Kaptoge et al., 2010).”
BackgroundInverse Relation of Dietary Protein Markers With Blood Pressure
Stamler, J. F., Elliott, P., Kesteloot, H., Nichols, R., Claeys, G., Dyer, A. R., & Stamler, R. (1996) · Circulation · doi:10.1161/01.cir.94.7.1629 · Cited by 202 · see citing works
Self-citationThe DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-Sodium)
SVETKEY, L. P., SACKS, F. M., OBARZANEK, E., VOLLMER, W. M., APPEL, L. J., LIN, P.-H., KARANJA, N. M., HARSHA, D. W., BRAY, G. A., AICKIN, M., et al. (1999) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(99)00423-x · Cited by 203 · see citing works
Treatment blood pressure targets for hypertension
Arguedas, J. A., Perez, M. I., & Wright, J. M. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004349.pub2 · Cited by 203 · see citing works
Physician‐Pharmacist Comanagement of Hypertension: A Randomized, Comparative Trial
Borenstein, J. E., Graber, G. R., Saltiel, E., Wallace, J. F., Ryu, S., Jackson, A., Deutsch, S., & Weingarten, S. R. (2003) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.23.2.209.32096 · Cited by 200 · see citing works
Systolic pressure is all that matters
Williams, B., Lindholm, L. H., & Sever, P. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60804-1 · Cited by 198 · see citing works
Pereira, M. A., Folsom, A. R., McGovern, P. G., Carpenter, M. A., Arnett, D. K., Liao, D., Szklo, M., & Hutchinson, R. G. (1999) · Preventive Medicine · doi:10.1006/pmed.1998.0431 · Cited by 195 · see citing works
Ostchega, Y., Carroll, M. D., Prineas, R. J., McDowell, M., Louis, T., & Tilert, T. J. (2008) · American Journal of Hypertension · doi:10.1038/ajh.2008.312 · Cited by 193 · see citing works
Improving Blood Pressure Control in a Pharmacist‐Managed Hypertension Clinic
Vivian, E. (2002) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.22.17.1533.34127 · Cited by 194 · see citing works
Barlow, C. E., LaMonte, M. J., FitzGerald, S. J., Kampert, J. B., Perrin, J. L., & Blair, S. N. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwj019 · Cited by 190 · see citing works
Moore, T. J., Conlin, P. R., Ard, J. D., & Svetkey, L. P. (2001) · Hypertension · doi:10.1161/01.hyp.38.2.155 · Cited by 189 · see citing works
Miura, K., Dyer, A. R., Greenland, P., Daviglus, M. L., Hill, M., Liu, K., Garside, D. B., & Stamler, J. (2001) · Hypertension · doi:10.1161/01.hyp.38.2.232 · Cited by 181 · see citing works
“Discussion The main findings from this 25-year follow-up study on CHD, CVD, and all-cause mortality for 5 age/gender–specific cohorts from an employed population are that (1) relations of PP were less strong than were those of SBP for all end points in all age/gender groups studied, (2) relations of PP were less stron…”
BackgroundResultSelf-citationElliott, K. J., Sale, C., & Cable, N. T. (2002) · British Journal of Sports Medicine · doi:10.1136/bjsm.36.5.340 · Cited by 180 · see citing works
Hypertension and coronary heart disease
Escobar, E. (2002) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001345 · Cited by 179 · see citing works
Vascular stiffening and arterial complianceImplications for systolic blood pressure
Schiffrin, E. L. (2004) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2004.08.019 · Cited by 180 · see citing works
McLean, G., Band, R., Saunderson, K., Hanlon, P., Murray, E., Little, P., McManus, R. J., Yardley, L., & Mair, F. S. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000859 · Cited by 168 · see citing works
“…as being when SBP is above 140mmHg and/or DBP is above 90mmHg (http://www. cardiovascular disease (CVD), which is the leading cause of premature morality worldwide [1]. significant effects and improvements in mortality can be achieved with relatively small reductions in blood pressure levels [2,3].”
BackgroundRisk factors for myocardial infarction in Brazil
Piegas, L. S., Avezum, Á., Pereira, J. C. R., Neto, J. M. R., Hoepfner, C., Farran, J. A., Ramos, R. F., Timerman, A., & Esteves, J. P. (2003) · American Heart Journal · doi:10.1016/s0002-8703(03)00181-9 · Cited by 180 · see citing works
O’Donnell, C. J., Ridker, P. M., Glynn, R. J., Berger, K., Ajani, U. A., Manson, J. E., & Hennekens, C. H. (1997) · Circulation · doi:10.1161/01.cir.95.5.1132 · Cited by 176 · see citing works
- Authors
- Stamler, J.
- Corresponding author
- Stamler, Jeremiah
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1993-03-08
- Volume
- 153
- Issue
- 5
- Pages
- 598
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2608915729
- Cited by
- 1,015
- References
- 0
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 17 · 2023: 24 · 2022: 22 · 2021: 27 · 2020: 26 · 2019: 31 · 2018: 39 · 2017: 24 · 2016: 21 · 2015: 36 · 2014: 30 · 2013: 31 · 2012: 43
- FWCI
- 12.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure, systolic blood pressure, diastolic blood pressure, cardiovascular risk, hypertension, coronary artery disease, stroke, cardiovascular mortality, life expectancy, primary prevention, hypertension control, National High Blood Pressure Education Program, population-based prevention
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