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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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“[33] highlighted that observational studies have demonstrated graded associations between higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) and an increased CVD risk [34,35].”
Backgroundvan der Sande, N. G. C., de Beus, E., Bots, M. L., Voskuil, M., Blankestijn, P. J., Visseren, F. L. J., & Spiering, W. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001494 · Cited by 19
Hirono, A., Kusunose, K., Kageyama, N., Sumitomo, M., Abe, M., Fujinaga, H., & Sata, M. (2017) · Journal of Cardiology · doi:10.1016/j.jjcc.2017.06.010 · Cited by 19
Taing, K. Y., Farkouh, M. E., Moineddin, R., Tu, J. V., & Jha, P. (2017) · BMC Obesity · doi:10.1186/s40608-017-0173-1 · Cited by 19
Outpatient physical therapy cardiovascular assessment: Physical therapist perspective and experience
Albarrati, A. (2018) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1458355 · Cited by 19
Boruzs, K., Juhász, A., Nagy, C., Szabó, Z., Jakovljević, M., Bíró, K., & Ádány, R. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.00839 · Cited by 19
“Since hypertension is one of the most robust predictors of CVD risk (Rapsomaniki et al., 2014) antihypertensive treatment for blood pressure reduction is particularly important.”
BackgroundShim, J., Jung, S. J., & Kim, H. C. (2019) · Clinical Hypertension · doi:10.1186/s40885-019-0130-z · Cited by 19
Hypertension Programmed in Adult Hens by Isolated Effects of Developmental Hypoxia In Ovo
Skeffington, K. L., Beck, C., Itani, N., Niu, Y., Shaw, C. J., & Giussani, D. A. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.15045 · Cited by 18
“533 Hypertension is a risk factor for adverse cardiovascular events.(1,2) It is well known that an individual’s risk of developing hypertension is affected by genetics, lifestyle choices, and the interaction between the two.”
BackgroundNiu, M., Wang, Y., Zhang, L., Tu, R., Liu, X., Hou, J., Huo, W., Mao, Z., Wang, C., & Bie, R. (2021) · Hypertension Research · doi:10.1038/s41440-021-00738-7 · Cited by 19
“Hypertension, a chronic disease prevalent throughout the world, is the most common risk factor for cardiovascular disease, and it common has environmental and inherited causes [1 – 3].”
BackgroundAppiah, C. A., Afriyie, E. O., Hayford, F. E. A., & Frimpong, E. (2020) · Pan African Medical Journal · doi:10.11604/pamj.2020.36.136.16861 · Cited by 18
“It has been documented that aging is associated with high blood pressure [28].”
BackgroundGravidity, parity, blood pressure and mortality among women in Bangladesh from the HEALS cohort
Shih, Y.-H., Bryan, M. S., Parvez, F., Uesugi, K., Shahriar, M., Ahmed, A., Islam, T., Ahsan, H., & Argos, M. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037244 · Cited by 19
Valookaran, A. F., Bouchard, J., Aloud, B. M., Thandapilly, S. J., & Netticadan, T. (2022) · Molecules · doi:10.3390/molecules27217222 · Cited by 21
“Observational trials have reported an increased risk of cardiovascular disease as SBP and DBP increase [17].”
BackgroundKim, S., Halvorsen, C., & Han, S. H. (2023) · Innovation in Aging · doi:10.1093/geroni/igad048 · Cited by 18
“Given that high blood pressure is associated with a variety of health ailments and associated health care costs for individuals and society (Rapsomaniki et al., 2014), these results provide support for the call for volunteering to be seen as a public health intervention (Jenkinson et al., 2013).”
BackgroundResultDePalma, S. M., Himmelfarb, C. D., MacLaughlin, E. J., & Taler, S. J. (2018) · JAAPA · doi:10.1097/01.jaa.0000533656.93911.38 · Cited by 18
Determining the Optimal Systolic Blood Pressure for Hypertensive Patients: A Network Meta-analysis
Fei, Y., Tsoi, M. F., & Cheung, B. M. Y. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.08.013 · Cited by 18
Larkins, N., Teixeira-Pinto, A. M., Kim, S., Burgner, D. P., & Craig, J. C. (2019) · Pediatric Nephrology · doi:10.1007/s00467-019-04206-w · Cited by 18
Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm
Fattahi, N., Rosenblad, A., Kragsterman, B., & Hultgren, R. (2020) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2019.11.062 · Cited by 20
Li, W., Zhao, J., Song, L., Chen, S., Liu, X., & Wu, S. (2020) · Clinical Cardiology · doi:10.1002/clc.23372 · Cited by 18
“People with hypertension (blood pressure ≥140/90 mm Hg or treatment with antihypertensive medications) have a significant lifetime risk of overall CVD by 30 years of age.(9) Given a systolic blood pressure (SBP) of 115 mm Hg and diastolic blood pressure (DBP) of 75 mm Hg, each 20 mm Hg increase in SBP (or an equivalen…”
BackgroundLee, S., Han, K., Kim, H., Cho, J., Yoon, K., & Kim, M. K. (2020) · Endocrinology and Metabolism · doi:10.3803/enm.2020.704 · Cited by 17
Niemann, B., Li, L., Simm, A., Molenda, N., Kockskämper, J., Boening, A., & Rohrbach, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-81438-7 · Cited by 16
Management of Small Incidental Intracranial Aneurysms
Burkhardt, J., Benet, A., & Lawton, M. T. (2017) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2017.02.006 · Cited by 18
“Hypertension should be medically treated to normal pressure range to prevent rupture risk as recommended in other vascular diseases.(12) Also it has been described that hypertensionmay lead to the formation of intracranial aneurysms and growth.”
BackgroundPapademetriou, V., Tsioufis, C. P., Chung, A., Geladari, C. V., & Andreadis, E. A. (2018) · Journal of Clinical Hypertension · doi:10.1111/jch.13371 · Cited by 16
Hypertension (Blood Pressure) and Lifetime Risk of Target Organ Damage
Jones, D. W., & Clark, D. C. (2020) · Current Hypertension Reports · doi:10.1007/s11906-020-01086-6 · Cited by 17
Chen, Z., Zhang, H., Bai, Y., Cui, C., Li, S., Wang, W., Deng, Y., Gao, Q., Wang, L., Qi, W., et al. (2021) · Science China Life Sciences · doi:10.1007/s11427-020-1852-x · Cited by 17
Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022
Orozco‐Beltrán, D., Cuixart, C. B., Banegas, J. R., Gil-Guillén, V. F., Cuenca, A. M. C., Rioboó, E. M., Baldó, A. J., Vicuña, J., & Pérez, J. N. (2022) · Atención Primaria · doi:10.1016/j.aprim.2022.102444 · Cited by 64
Circulatory miRNAs in essential hypertension
Kostiniuk, D., Marttila, S., & Raitoharju, E. (2024) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2024.119069 · Cited by 17
Secondary Stroke Prevention: Improving Diagnosis and Management with Newer Technologies
Imam, Y. Z. B., D’Souza, A., Malik, R. A., & Shuaib, A. M. (2016) · Translational Stroke Research · doi:10.1007/s12975-016-0494-2 · Cited by 18
Maternal prepregnancy BMI or weight and offspring's blood pressure: Systematic review
Ludwig‐Walz, H., Schmidt, M., Günther, A. L. B., & Kroke, A. (2017) · Maternal and Child Nutrition · doi:10.1111/mcn.12561 · Cited by 16
Yeates, K., Campbell, N. R. C., Maar, M. A., Perkins, N. J., Liu, P. P., Sleeth, J., Smith, C. L., McAllister, C., Hua‐Stewart, D., Wells, G. A., et al. (2017) · JMIR Research Protocols · doi:10.2196/resprot.7139 · Cited by 17
“Hypertension increases the burden of disease globally through cardiovascular disease, kidney disease, and dementia [2-4].”
Quantity, Quality, and Timing of Carbohydrate Intake and Blood Pressure
Byun, S. S., Mayat, Z., Aggarwal, B., Parekh, N., & Makarem, N. (2019) · Current Nutrition Reports · doi:10.1007/s13668-019-00277-1 · Cited by 18
Rivasi, G., Brignole, M., Rafanelli, M., Bilo, G., Pengo, M. F., Ungar, A., & Parati, G. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002555 · Cited by 18
Taleb, S., Boulaba, K., Yousfi, A., Taleb, N., Difallah, B., & Negrichi, S. (2020) · Environmental Science and Pollution Research · doi:10.1007/s11356-020-10122-6 · Cited by 17
“…reports were made by other authors who have shown that high blood pressure promotes the risk of various cardiovascular diseases (Flint et al. 2019; Rapsomaniki et al. 2014; Whelton et al. 2017), such as strokes, coronary heart disease, heart failure, fibrillation atrial (Angeli et al. 2014), and…”
ResultEffect of High-velocity Resistance Exercise on 24-h Blood Pressure in Hypertensive Older Women
Dantas, F. F. O., Browne, R. A. V., Oliveira, R. S., Cabral, L. L. P., Farias-Junior, L. F., & Costa, E. C. (2020) · International Journal of Sports Medicine · doi:10.1055/a-1202-1536 · Cited by 17
“Hypertension is highly prevalent in older adults [1, 2] and is a major risk factor for cardiovascular diseases and stroke [3], which are the leading causes of death worldwide [4].”
BackgroundDefining the risk profile of women with stage 1 hypertension: a time to event analysis
Sabol, B., Porcelli, B. A., Diveley, E., Meyenburg, K., Woolfolk, C., Rosenbloom, J. I., Raghuraman, N., & Stout, M. J. (2021) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2021.100376 · Cited by 18
Jang, D.-J., Bae, S. K., & Oh, E. (2014) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2014.10.010 · Cited by 17
Haapio, E., Kiviniemi, T., Irjala, H., Koivunen, P. T., Airaksinen, J. K. E., & Kinnunen, I. (2016) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-4164-5 · Cited by 17
“Hypertension is a strong risk factor for cardiac and cerebrovascular complications in the general population [16].”
BackgroundHuang, C., Chen, Y., Hung, C., Lee, J., Hsu, T., Wu, H., Chuang, P., Chen, M.-F., & Ho, Y. (2019) · Journal of Medical Internet Research · doi:10.2196/12369 · Cited by 17
Murad, M. H., Larrea-Mantilla, L., Haddad, A., Spencer‐Bonilla, G., Serrano, V., Rodríguez‐Gutiérrez, R., Álvarez‐Villalobos, N. A., Benkhadra, K., Gionfriddo, M. R., Prokop, L. J., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-00197 · Cited by 17
Al‐Alusi, M. A., Friedman, S. F., Kany, S., Rämö, J. T., Pipilas, D. C., Singh, P., Reeder, C., Khurshid, S. S., Pirruccello, J. P., Maddah, M., et al. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01491-8 · Cited by 20
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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