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The main end points in human hypertension
Insights
High blood pressure increases risks for heart attack and stroke, with varying impacts based on age and other health factors like lipids and smoking. Population differences in cardiovascular disease incidence are significant.
Area of Science:
- Cardiovascular epidemiology
- Public health
Background:
- Prospective studies show rising total mortality, myocardial infarction (MI), and sudden coronary death (SD) with increased blood pressure.
- Stroke incidence increases with blood pressure, particularly in older adults and some women, becoming as common as MI/SD at highest levels.
Purpose of the Study:
- To examine the relationship between blood pressure and mortality from cardiovascular events and other causes.
- To investigate how factors like serum lipids, smoking, and population demographics modify these risks.
Main Methods:
- Analysis of prospective data from Western populations.
- Comparison of incidence rates for MI, SD, and stroke across different blood pressure levels and demographic groups.
- Review of existing epidemiologic studies and intervention trials.
Main Results:
- Blood pressure is a key risk factor for MI, SD, and stroke.
- MI and SD risk are strongly influenced by serum lipids and smoking; stroke risk is less dependent on these factors.
- Significant international variations exist in MI, SD, and stroke mortality rates (e.g., US vs. Japan).
- Blood pressure may also influence non-cardiovascular mortality, including cancer.
Conclusions:
- Elevated blood pressure is a critical determinant of cardiovascular mortality.
- The impact of blood pressure on cardiovascular events is modified by other risk factors and population-specific characteristics.
- Further research into blood pressure's role in non-cardiovascular mortality is warranted.
Abstract:
Prospective data from Western populations show a fairly steady increase in the incidence of total mortality as well as of myocardial infarction (MI) and sudden coronary death (SD) with increasing blood pressure levels. In the age groups up to 70 years, stroke is much less common than MI and SD at virtually all blood pressure levels, but for older men and also for somewhat younger women, stroke is as common as MI and SD at the highest blood pressure levels. The incidence of MI and SD is strongly dependent on serum lipid abnormalities and smoking habits, whereas stroke appears to depend very little on lipid levels and in only a few studies appears related to smoking habits. Thus, the effect of blood pressure is appreciably modified by the presence of some other abnormalities that are believed to enhance coronary arteriosclerosis. There are major differences between populations with respect to the incidence of MI, SD, and stroke. MI mortality and SD have, for example, been very high in the United States, whereas stroke mortality has been low. In Japan, on the other hand, stroke mortality has been high and MI mortality and SD have been low. Sweden has occupied an intermediate position with respect to MI mortality and SD, which have been increasing slightly while they have been decreasing in the United States, whereas stroke mortality in Sweden and in the other Scandinavian countries has been very low and is even showing a slight decrease. Both prospective epidemiologic studies and intervention trials indicate some influence of blood pressure on noncardiovascular mortality, such as that from cancer.