High blood pressure and end-organ damage

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Epidemiology

Background:

• Numerous studies confirm a strong, consistent link between blood pressure levels and cardiovascular-renal diseases.
• This relationship applies to both subclinical and clinical, nonfatal and fatal conditions.

Purpose of the Study:

• To review evidence from prospective observational studies and randomized clinical trials on blood pressure and cardiovascular-renal outcomes.
• To evaluate the predictive power of systolic versus diastolic blood pressure and the continuous nature of these associations.

Main Methods:

• Analysis of data from the Multiple Risk Factor Intervention Trial (MRFIT) and the Framingham Heart Study.
• Review of 17 large-scale randomized trials evaluating blood pressure-lowering drug regimens.
• Examination of associations with coronary heart disease, stroke, end-stage renal disease, peripheral vascular disease, heart failure, and left ventricular hypertrophy.

Main Results:

• Systolic blood pressure is a stronger predictor of cardiovascular events than diastolic pressure.
• Associations between blood pressure and cardiovascular/renal diseases extend across the entire pressure range, including normotensive levels.
• Randomized trials show significant reductions in fatal/nonfatal stroke and coronary heart disease with blood pressure-lowering treatments.

Conclusions:

• Blood pressure-lowering treatments significantly reduce the risk of major cardiovascular events like stroke and heart attack.
• Evidence for the health benefits of further reducing blood pressure in normotensive individuals is limited.