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Effects of elevated systolic blood pressure on ischemic heart disease: a Burden of Proof study

Christian Razo1,2, Catherine A Welgan3, Catherine O Johnson4

  • 1Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. razoc@uw.edu.

Nature Medicine
|October 10, 2022
PubMed

Insights

High systolic blood pressure significantly increases ischemic heart disease risk, even at 120 mm Hg. Early screening and hypertension treatment are crucial for prevention.

Area of Science:

  • Cardiovascular epidemiology
  • Public health

Background:

  • High systolic blood pressure (SBP) is a primary risk factor for ischemic heart disease (IHD), a leading global cause of mortality.
  • Understanding the precise relationship between SBP and IHD risk is vital for effective public health strategies.

Purpose of the Study:

  • To quantify the dose-response relationship between SBP and IHD risk.
  • To assess the burden of proof risk function (BPRF) and develop a risk outcome score (ROS) with a star rating for SBP levels.

Main Methods:

  • Meta-analysis of published observational studies and controlled trials on SBP and IHD.
  • Estimation of the SBP-IHD dose-response function and BPRF.
  • Calculation of a risk outcome score (ROS) and star rating (one to five).

Main Results:

  • A strong, significant harmful effect of SBP on IHD was observed.
  • IHD risk increased substantially with SBP: 1.39 at 120 mm Hg, 1.81 at 130 mm Hg, and 4.48 at 165 mm Hg (relative to 100 mm Hg).
  • SBP exposure between 107.5 and 165.0 mm Hg raised IHD risk by 101.36% on average, resulting in a ROS of 0.70 and a five-star rating.

Conclusions:

  • IHD risk begins to rise at 120 mm Hg SBP and increases steadily up to 165 mm Hg.
  • Strengthened screening, timely hypertension diagnosis and treatment, and primordial prevention strategies are essential.
  • Increased resources are needed to further understand the primordial prevention of elevated blood pressure.

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