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Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people
Open accessAbstract
BACKGROUND: The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. METHODS: We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371. FINDINGS: During 5·2 years median follow-up, we recorded 83,098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90-114 mm Hg and diastolic blood pressure of 60-74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32-1·58]), subarachnoid haemorrhage (1·43 [1·25-1·63]), and stable angina (1·41 [1·36-1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00-1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86-0·98]) and strongest for peripheral arterial disease (1·23 [1·20-1·27]). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9-63·8) compared with 46·1% (45·5-46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8-5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years. INTERPRETATION: The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them. FUNDING: Medical Research Council, National Institute for Health Research, and Wellcome Trust.
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“High blood pressure (BP) is the single leading risk factor for cardiovascular disease worldwide,1–4”
From International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action (2023) · cites this paper as [4]
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“Hypertension (HTN) is a well-known risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD) [1,2].”
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Odden, M. C., Beilby, P. R., & Peralta, C. A. (2015) · Current Hypertension Reports · doi:10.1007/s11906-015-0564-y · Cited by 55
“25 million patient records.[13] In this study, the authors reported a linear association between blood pressure and nearly all of 12 cardiovascular outcomes, across all ages.”
Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases
Pujades‐Rodríguez, M., Duyx, B., Thomas, S. L., Stogiannis, D., Smeeth, L. L., & Hemingway, H. (2016) · Heart · doi:10.1136/heartjnl-2015-308514 · Cited by 53
Self-citationSignatures of miR-181a on the Renal Transcriptome and Blood Pressure
Marques, F. Z., Romaine, S. P. R., Denniff, M. J., Eales, J., Dormer, J., Garrelds, I. M., Wojnar, Ł., Musialik, K., Duda-Raszewska, B., Kiszka, B., et al. (2015) · Molecular Medicine · doi:10.2119/molmed.2015.00096 · Cited by 53
Screening and treatment of hypertension in older adults: less is more?
Anker, D., Santos‐Eggimann, B., Santschi, V., Giovane, C. D., Wolfson, C. M., Streit, S., Rodondi, N., & Chioléro, A. (2018) · Public health reviews · doi:10.1186/s40985-018-0101-z · Cited by 54
Plummer, C., Michael, A., Shaikh, G., Stewart, M., Buckley, L., Miles, T., Ograbek, A., & McCormack, T. (2019) · British Journal of Cancer · doi:10.1038/s41416-019-0481-y · Cited by 52
Roxadustat prevents Ang II hypertension by targeting angiotensin receptors and eNOS
Yu, J., Wang, S., Shi, W., Zhou, W., Niu, Y., Huang, S., Zhang, Y., Zhang, A., & Jia, Z. (2021) · JCI Insight · doi:10.1172/jci.insight.133690 · Cited by 56
“Mild high blood pressure generally does not cause obvious symptoms, while long-term high blood pressure is a major risk factor for cardiovascular disease, heart failure, chronic kidney disease (CKD), stroke, peripheral vascular disease, and dementia (3, 4).”
BackgroundTorres, J. M., Deardorff, J., Gunier, R. B., Harley, K. G., Alkon, A., Kogut, K. R., & Eskenazi, B. (2018) · Annals of Behavioral Medicine · doi:10.1093/abm/kax007 · Cited by 56
“However, deportation worry was associated with higher systolic blood pressure, which has been linked to congestive heart failure, myocardial infarction, and stable angina, as well as higher pulse pressure, which has been shown to be a significant predictor of congestive heart failure and peripheral arterial disease [2…”
BackgroundCalabria, B., Korda, R., Lovett, R. W., Fernando, P., Martin, T., Malamoo, L., Welsh, J., & Banks, E. (2018) · The Medical Journal of Australia · doi:10.5694/mja17.00897 · Cited by 53
Diastolic Blood Pressure J-Curve Phenomenon in a Tertiary-Care Hypertension Clinic
Lip, S. Z. L., Tan, L. E., Jeemon, P., McCallum, L., Dominiczak, A. F., & Padmanabhan, S. (2019) · Hypertension · doi:10.1161/hypertensionaha.119.12787 · Cited by 52
“2 million patients not selected for hypertension.(15) For mortality outcomes, the results of our study concur with SYS-EUR (Systolic Hpertension in Europe Trial),(25) which also studied treated hypertensive patients, but not with the CLARIFY registry, which analyzed patients with CAD and hypertension.”
ResultArterial compliance probe for cuffless evaluation of carotid pulse pressure
Joseph, J., Nabeel, P. M., Shah, M. I., & Sivaprakasam, M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202480 · Cited by 52
Macrophage secretion of miR-106b-5p causes renin-dependent hypertension
Oh, J., Matkovich, S. J., Riek, A. E., Bindom, S. M., Shao, J.-S., Head, R. D., Barve, R. A., Sands, M. S., Carmeliet, G., Osei‐Owusu, P., et al. (2020) · Nature Communications · doi:10.1038/s41467-020-18538-x · Cited by 51
Davidson, J. A., Banerjee, A., Smeeth, L. L., McDonald, H. I., Grint, D. J., Herrett, E. L., Forbes, H. J., Pebody, R. G., & Warren‐Gash, C. (2021) · The Lancet Digital Health · doi:10.1016/s2589-7500(21)00203-x · Cited by 51
Self-citationKoba, A., Yamagishi, K., Sairenchi, T., Noda, H., Irie, F., Takizawa, N., Tomizawa, T., Iso, H., & Ota, H. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.027045 · Cited by 51
Prevalence of Cerebral Microbleeds in Patients With Continuous‐Flow Left Ventricular Assist Devices
Yoshioka, D., Okazaki, S., Toda, K., Murase, S., Saito, S., Domae, K., Miyagawa, S., Yoshikawa, Y., Daimon, T., Sakaguchi, M., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.005955 · Cited by 51
Circadian Rhythm of Cardiovascular Disease: The Potential of Chronotherapy With Aspirin
Buurma, M., van Diemen, J. J. K., Thijs, A., Numans, M. E., & Bonten, T. N. (2019) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2019.00084 · Cited by 55
Wu, C., Smit, E., Peralta, C. A., Sarathy, H., & Odden, M. C. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14816 · Cited by 51
“There has been a large body of epidemiological evidence showing low BP is associated with increased risk of cardiovascular (CV) events, poor physical and cognitive functions, and mortality in elders; whereas other studies have reported elevated BP remains to be a risk factor for CV outcomes and mortality in old age.(1…”
BackgroundBörschel, C. S., & Schnabel, R. B. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.11.123 · Cited by 52
Lü, Y., Ballew, S. H., Tanaka, H., Szklo, M., HEISS, G. M., Coresh, J., & Matsushita, K. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319865378 · Cited by 51
Association between neighbourhood deprivation and hypertension in a US-wide Cohort
Xu, J., Lawrence, K. G., O’Brien, K. M., Jackson, C. L., & Sandler, D. P. (2021) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2021-216445 · Cited by 51
Boodhna, T., & Crabb, D. P. (2014) · Ophthalmic and Physiological Optics · doi:10.1111/opo.12187 · Cited by 49
“14 There are some good recent examples of this type of research methodology used in ophthalmology where examination of large data sets from several clinical centres can be used to complement information gleaned from traditional audits.”
Ye, X., Qian, Y., Shao, J., Zhang, Y., Zha, M., Yang, Q., Xia, W., Ye, Z., & Song, P. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.627741 · Cited by 49
Calcium supplementation for prevention of primary hypertension
Cormick, G., Ciapponi, A., Cafferata, M. L., Cormick, M. S., & Belizán, J. M. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010037.pub3 · Cited by 50
Wang, M., Brage, S., Sharp, S. J., Luo, S., Yeung, S. L. A., & Kim, Y. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac135 · Cited by 48
Baffour, P. K., Jahangiry, L., Jain, S., Sen, A., & Aune, D. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad344 · Cited by 48
Cífková, R., Pitha, J. V., Krajčoviechová, A., & Králíková, E. (2019) · International Journal of Cardiology · doi:10.1016/j.ijcard.2019.01.039 · Cited by 47
2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure
Casey, D. E., Thomas, R. J., Bhalla, V., Commodore-Mensah, Y. Y., Heidenreich, P. A., Kolte, D. S., Muntner, P., Smith, S. C., Spertus, J. A., Windle, J. R., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.10.001 · Cited by 48
Mahmood, S., Jalal, Z., Hadi, M. A., Orooj, H., & Shah, K. U. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s235517 · Cited by 51
“infarction, congestive heart failure, renal failure and blindness.(1,2) In 2010, 1.”
BackgroundDalager, T., Justesen, J. B., Murray, M., Boyle, E., & Sjøgaard, G. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-016-3397-8 · Cited by 48
“This is also supported by Rapsomaniki et al., who found that for all ages, the lowest risk for cardiovascular diseases was in individuals with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg (Rapsomaniki et al. 2014).”
BackgroundResultBlood pressure estimation using video plethysmography
Šećerbegović, A., Bergsland, J., Halvorsen, P. S., Suljanović, N., Mujčić, A., & Balasingham, I. (2016) · IEEE International Symposium on Biomedical Imaging (ISBI) · doi:10.1109/isbi.2016.7493307 · Cited by 47
Helicobacter pylori infection and prevalence of high blood pressure among Chinese adults
Wan, Z., Liu, H., Hu, M. Y., Lei, X., Huang, Y., & Lv, Y. (2017) · Journal of Human Hypertension · doi:10.1038/s41371-017-0028-8 · Cited by 47
Blood pressure, heart rate, and mortality in chronic obstructive pulmonary disease: the SUMMIT trial
Byrd, J. B., Newby, D. E., Anderson, J. A., Calverley, P. M. A., Celli, B. R., Cowans, N. J., Crim, C. C., Martínez, F. J., Vestbo, J., Yates, J., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy451 · Cited by 50
“Discussion Elevated BP levels above ideal (>115/75 mm Hg) are monotonically linked to increased morbidity and mortality in the general population.(9,10) However, the prognostic value of high BP specifically among individuals with COPD remains poorly described.”
BackgroundInfluentialYamada, Y., Kato, K., Oguri, M., Horibe, H., Fujimaki, T., Yasukochi, Y., Takeuchi, I., & Sakuma, J. (2018) · International Journal of Molecular Medicine · doi:10.3892/ijmm.2018.3852 · Cited by 48
“As hypertension is a major risk factor for cAd and stroke (20), personalized prevention of hypertension is an important public health goal.”
New blood pressure associated loci identified in meta-analyses of 475,000 individuals
Howson, J. M. M., Danesh, J., Surendran, P., & Butterworth, A. S. (2017) · Oxford University Research Archive (ORA) (University of Oxford) · doi:10.17863/cam.13725 · Cited by 50
Cao, X., Zhao, Z., Kang, Y., Tian, Y., Song, Y., Wang, L., Zhang, L., Wang, X., Chen, Z., Zheng, C., et al. (2022) · The Lancet Public Health · doi:10.1016/s2468-2667(22)00232-8 · Cited by 48
Wu, S., Zou, H., Zhu, G., Wang, L., Zhang, Q., Shi, K., Han, J., Huang, W., Braddock, M., Chen, Y., et al. (2015) · Medicine · doi:10.1097/md.0000000000000842 · Cited by 46
“All rights reserved. to better understand the relationship between NAFLD and increased BP.”
BackgroundInfluentialLi, M., Tjen‐A‐Looi, S. C., Guo, Z., & Longhurst, J. C. (2016) · Scientific Reports · doi:10.1038/srep35791 · Cited by 46
“The efficacy of EA in lowering SBP may be important for patients with advancing age ( > 60 years) 38 since stress-related spikes in SBP places patients with hypertension at risk for stroke, developing peripheral artery disease, heart failure, as well as myocardial infarction and other…”
New Blood Pressure–Associated Loci Identified in Meta-Analyses of 475 000 Individuals
Kraja, A. T., Cook, J. P., Warren, H. R., Surendran, P., Liu, C., Evangelou, E., Manning, A. K., Grarup, N., Drenos, F., Sim, X., et al. (2017) · Circulation Cardiovascular Genetics · doi:10.1161/circgenetics.117.001778 · Cited by 46
“High blood pressure (BP) is a major risk factor for coronary artery disease, heart failure, stroke, renal failure, and premature mortality.(1) High BP has been estimated to cause 10.”
BackgroundRahimi, K., Mohseni, H., Otto, C. M., Conrad, N., Tran, J., Nazarzadeh, M., Woodward, M., Dwyer, T., & MacMahon, S. W. (2017) · PLoS Medicine · doi:10.1371/journal.pmed.1002404 · Cited by 51
Metadata
- Authors
- Rapsomaniki, E., Timmis, A., George, J., Pujades-Rodriguez, M., Shah, A. D., Denaxas, S., White, I. R., Caulfield, M. J., Deanfield, J. E., Smeeth, L., Williams, B., Hingorani, A., & Hemingway, H.
- Affiliations
- Farr Institute (GB)
- Queen Mary University of London (GB)
- MRC Biostatistics Unit (GB)
- London School of Hygiene & Tropical Medicine (GB)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Rapsomaniki, Eleni
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 383
- Issue
- 9932
- Pages
- 1899-1911
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC4042017
- OpenAlex
- W2169428949
- Cited by
- 1,643
- References
- 41
- Citations by year
- 2026: 79 · 2025: 117 · 2024: 145 · 2023: 161 · 2022: 162 · 2021: 192 · 2020: 168 · 2019: 163 · 2018: 142 · 2017: 117 · 2016: 94 · 2015: 66 · 2014: 34
- FWCI
- 71.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research (NIHR) (RP-PG-0407–10314)
- Wellcome Trust (086091/Z/08/Z, 0938/30/Z/10/Z)
- Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership (G0902393/99558)
- Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, NIHR, National Institute for Social Care and Health Research, and Wellcome Trust (MR/K006584/1)
- NIHR Doctoral Fellowship (DRF-2009–02–50)
- Medical Research Council (U105260558)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- blood pressure, cardiovascular disease incidence, systolic blood pressure, diastolic blood pressure, pulse pressure, lifetime risk, healthy life years lost, intracerebral hemorrhage, subarachnoid hemorrhage, myocardial infarction, stable angina, peripheral arterial disease, abdominal aortic aneurysm, stroke, hypertension, age-specific associations, blood pressure-lowering treatment, J-curve
- MeSH terms
- Acute Disease, Adult, Aged, Aged, 80 and over, Angina Pectoris, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Chronic Disease, England, Female, Follow-Up Studies, Humans, Hypertension, Male, Medical Record Linkage, Middle Aged, Subarachnoid Hemorrhage, Incidence, Aortic Aneurysm, Abdominal, Age Distribution, Risk Assessment, Intracranial Hemorrhage, Hypertensive
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