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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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“This could be explained by the high prevalence of both diseases in the general population.(16,17) In Bahrain, the prevalence of diabetes and hypertension is high, at 15% and 33%, respectively.”
BackgroundIncreased blood pressure after nonsevere COVID-19
Schmidt‐Lauber, C., Schmidt, E. A., Hänzelmann, S., Petersen, E. L., Behrendt, C., Twerenbold, R., Blankenberg, S., Huber, T. B., & Wenzel, U. O. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003522 · Cited by 14
“Hypertension is closely associated with various cardiovascular diseases, which have been observed after COVID19 [5], and could therefore constitute another feature within the post-COVID-19 condition complex.”
Evening versus morning dosing regimen drug therapy for hypertension
Wu, C., Zhao, P., Xu, P., Wan, C., Singh, S., Varthya, S. B., & Luo, S. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004184.pub3 · Cited by 14
Qiu, W., Cai, A., Li, L., & Feng, Y. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02227-w · Cited by 15
“Although DBP does not have comparable impacts as SBP on health [39], PP, a well-recognized surrogate of arterial stiffness calculated by subtracting DBP from SBP, is a critical predictor for CVD [40].”
BackgroundKadoglou, N. P. E., Mouzarou, A., Hadjigeorgiou, N., Korakianitis, I., & Myrianthefs, M. M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13092708 · Cited by 14
“Recent evidence suggests the co-existence of AH in 76% of newly diagnosed HF cases [7], and individuals with AH have an almost twofold higher lifetime risk of HF development compared to those with normal BP [8].”
BackgroundWang, D., Hatahet, M., Wang, Y., Liang, H., Bazikian, Y., & Bray, C. L. (2019) · Blood Pressure · doi:10.1080/08037051.2019.1593042 · Cited by 14
“Blood pressure (BP) control is crucial in the prevention of adverse cardiovascular outcomes [1].”
BackgroundPediatric Obesity, Hypertension, Lipids
Leopold, S., & Zachariah, J. P. V. (2020) · Current Treatment Options in Pediatrics · doi:10.1007/s40746-020-00188-2 · Cited by 17
Lewer, D., Padmanathan, P., Arfeen, M. Q. U., Denaxas, S., Forbes, H. J., González-Izquierdo, A., & Hickman, M. (2020) · Wellcome Open Research · doi:10.12688/wellcomeopenres.16431.1 · Cited by 14
Self-citationBlood pressure control and progression of arteriosclerosis in hypertension
Huang, Z., Wang, G., Jonas, J. B., Ji, C., Chen, S., Yuan, Y. L., Shen, C., Wu, Y., & Wu, S. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002758 · Cited by 14
Yu, Y., Chang, C., Wu, Y., Chengcheng, G. U. O., & Xie, L. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14340 · Cited by 15
Pharmacotherapy for hypertension-induced left ventricular hypertrophy
Leache, L., Gutiérrez‐Valencia, M., Finizola, R. M., Infante, E., Finizola, B., Pardo, J. P., Flores, Y., Granero, R., & Arai, K. J. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012039.pub3 · Cited by 14
Research Goes Red: Early Experience With a Participant-Centric Registry
Gilchrist, S. C., Hall, J. L., Khandelwal, A., Hidalgo, B., Aggarwal, B., Kinzy, C., Mallya, P., Conners, K., Stevens, L. M., Alger, H. M., et al. (2022) · Circulation Research · doi:10.1161/circresaha.121.320403 · Cited by 14
Psychosomatic Aspects of The Development of Comorbid Pathology: A Review
Tatayeva, R. K., Ossadchaya, E., Sarkulova, S., Sembayeva, Z., & Koigeldinova, S. (2022) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.36.152 · Cited by 20
“In addition, cardiovascular events in people with hypertension tend to appear about five years earlier than in those with lower levels of BP (52).”
Vinholes, D. B., Bassanesi, S. L., Chaves, H., Machado, C. A., Melo, I. M. F., Fuchs, F. D., & Fuchs, S. C. P. C. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015755 · Cited by 14
“As a consequence, hypertension continues to have a leading role among risk factors for coronary heart disease, stroke, heart failure and chronic kidney disease.(3) The consequences of hypertension and associated morbidities for the healthcare system increase the costs of providing long-term care and treatment, includi…”
BackgroundMatsutomo, T., Ushijima, M., Kunimura, K., & Ohtani, M. (2019) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2019.01.043 · Cited by 14
Zhang, J., Zhao, Z., Guo, X., Guo, B., & Wu, B. (2019) · Genetic Epidemiology · doi:10.1002/gepi.22251 · Cited by 14
“The summary data are performed by MAGIC consortium for a follow ‐ up replication study using a Metabochip consisting of a small panel of promising SNPs and a much larger sample size from 66 fasting glucose GWAS with around 133,010 nondiabetic participants (Scott et al., 2012).”
BackgroundMethodResultInfluentialYoon, Y., Park, G., Lee, J., Lee, J., Lee, H., Roh, J., Kim, J. H., Lee, P. H., Choe, J., Kim, Y., et al. (2021) · American Journal of Hypertension · doi:10.1093/ajh/hpab051 · Cited by 14
Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
Zuo, Y., Zheng, D., Chen, S., Yang, X., Yan, Y., Liu, F., Tian, X., Wang, M., Su, X., Wen, J., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.735679 · Cited by 14
Xueying, G., Tysinger, B., Wee, H. L., Subramaniam, M., Ma, S., Ng, T. P., & Chen, C. (2025) · Nature Aging · doi:10.1038/s43587-025-00915-0 · Cited by 13
ABO blood group system and occurrence of ischemic stroke
Rafaella Chiodini, L. O. T. Z., WELTER, C. D. S., Ramos, S. A., Ferreira, L. E., Cabral, N. L., & FRANÇA, P. H. C. D. (2021) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · Cited by 13
Soucie, J. M., Le, B. C., Dupervil, B., & Poston, J. N. (2022) · Haemophilia · doi:10.1111/hae.14647 · Cited by 13
Yang, Y., Song, L., Wang, L., Li, D., Chen, S., Wu, S., & Tian, Y. (2022) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2022.11.025 · Cited by 14
Oh, S.-H., Kim, D., Hwang, J., Kang, J., Kwon, Y., & Kwon, J. (2023) · JMIR Public Health and Surveillance · doi:10.2196/42190 · Cited by 15
Liang, X., Chou, O. H. I., & Cheung, B. M. Y. (2023) · Chronic Obstructive Pulmonary Diseases Journal of the COPD Foundation · doi:10.15326/jcopdf.2022.0306 · Cited by 13
Wu, Z., Jiang, Y., Zhu, Q., Zhang, H., Li, Z., Wang, J., Pan, H., Guo, Z., Zheng, Y., Li, X., et al. (2023) · JACC Asia · doi:10.1016/j.jacasi.2023.02.001 · Cited by 14
Khalaf, S. Y. A., Chappell, L. C., Khashan, A. S., McCarthy, F. P., & O’Reilly, É. J. (2023) · Hypertension · doi:10.1161/hypertensionaha.122.20628 · Cited by 13
“In the second classification, we subclassified the exposed and unexposed, according to the presence of APOs and chronic hypertension into the following time-varying categories: (1) neither chronic hypertension nor APOs, (2) no chronic hypertension with APOs, (3) chronic hypertension without APOs, and (4) chronic hyper…”
BackgroundMethodThe Intersection of Prostate Cancer and Hypertension: a Call to Action
Dolmatova, E. V., Waheed, N., Olson, B. M., Patel, S. A., & Mandawat, A. (2023) · Current Treatment Options in Oncology · doi:10.1007/s11864-023-01094-z · Cited by 17
Rakesh, P. S., Renjini, B. A., Mohandas, S., Menon, J. C., Numpelil, M., Sreedevi, A., & Vasudevan, B. K. (2023) · Indian Heart Journal · doi:10.1016/j.ihj.2023.06.004 · Cited by 13
Degree of Risk Factor Control and Incident Cardiovascular Diseases in Patients With Hypertension
Kou, M., Wang, X., Ma, H., Li, X., Heianza, Y., & Qi, L. (2024) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2023.05.008 · Cited by 12
Contemporary treatment options in heart failure with preserved ejection fraction
Peikert, A., & Solomon, S. D. (2024) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeae201 · Cited by 13
Genetic Risk Factors and Mendelian Randomization in Cardiovascular Disease
Swerdlow, D. I., Hingorani, A. D., & Humphries, S. E. (2015) · Current Cardiology Reports · doi:10.1007/s11886-015-0584-x · Cited by 14
Self-citationImportance of sustained and “tight” blood pressure control in patients with high cardiovascular risk
Meredith, P., Lloyd, S. M., Ford, I., & Elliott, H. L. (2016) · Blood Pressure · doi:10.3109/08037051.2015.1127528 · Cited by 13
“[26] This concept has been reinforced by retrospective analyses from recent clinical trials in patients at high cardiovascular risk.[9,23] However, a recent retrospective analysis of the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) study in patients with stable CAD failed to identify an…”
ResultWhat Is the Prevalence of Childhood Hypertension?
Daniels, S. R. (2018) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2018.0375 · Cited by 13
Stress and Blood Pressure in Dementia Caregivers: The Moderator Role of Mindfulness
Vara-García, C., Romero-Moreno, R., Márquez-González, M., Mausbach, B., von Känel, R., Gallego-Alberto, L., Olmos, R., & Losada, A. (2019) · Clinical Gerontologist · doi:10.1080/07317115.2018.1554611 · Cited by 15
“Because of the risk for various diseases attributable to elevated BP, it is estimated that between 1.6 and 5.0 years of life are lost due to the disease burden brought on by an elevated BP (Rapsomaniki et al., 2014).”
BackgroundInfluentialSobrepeso y obesidad en niños intervenidos de cardiopatía congénita
Perín, F., Blesa, C. C., del Rey, M. D. M. R. V., Cobo, I., & Maldonado, J. A. (2019) · Anales de Pediatría · doi:10.1016/j.anpedi.2018.03.005 · Cited by 13
Chen, X., Barywani, S. B., Hansson, P., Rosengren, A., Thunström, E. Ö., Zhong, Y., Ergatoudes, C., Mandalenakis, Z., Caidahl, K., & Fu, M. L. X. (2020) · Medicine · doi:10.1097/md.0000000000019895 · Cited by 13
Vors, C., Rancourt-Bouchard, M., Couillard, C., Gigleux, I., Couture, P., & Lamarche, B. (2021) · Nutrients · doi:10.3390/nu13020399 · Cited by 13
“Hypertension is a causal risk factor for a variety of cardiovascular diseases (CVDs) [1].”
BackgroundKleinloog, J. P. D., Mensink, R. P., Roodt, J. O. ’., Thijssen, D. H. J., Hesselink, M. K. C., & Joris, P. J. (2022) · Physiological Reports · doi:10.14814/phy2.15395 · Cited by 13
“Physical exercise training is a well- known strategy to prevent age- related health problems, such as cardiovascular disease (CVD) and cognitive decline (Benjamin et al., 2018; Rapsomaniki et al., 2014).”
BackgroundModesti, P. A., Omboni, S., Taddei, S., Ghione, S., Portaluppi, F., Pozzilli, P., Volpe, M., Arca, M., Calabrò, P., Fulgheri, P. D., et al. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000805 · Cited by 13
Optimal achieved blood pressure for patients with stable coronary artery disease
Huang, C., Leu, H., Yin, W., Tseng, W.-K., Wu, Y., Lin, T., Yeh, H., Chang, K., Wang, J., Wu, C., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-10628-z · Cited by 13
“Patients were enrolled only if (1) they had received successful PCI with either coronary stenting or balloon angioplasty at least once previously, and (2) they had been stable on medical treatment for at least 1 month before enrollment.”
BackgroundMethodResultClinical hypertension: Blood pressure variability
Malik, E., Abdulhadi, B., Mezue, K. N., Lerma, E. V., & Rangaswami, J. (2017) · Disease-a-Month · doi:10.1016/j.disamonth.2017.08.003 · Cited by 16
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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