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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 (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”
In the citing paper
“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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Metadata
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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