Even systolic BP increases within normal range raise ASCVD risk

  • JAMA Cardiol

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Systolic BP (SBP) increases even within normal range are linked to increased risk for atherosclerotic cardiovascular disease (ASCVD).
  • The stepwise risk increase begins with SBP as low as 100 mmHg.

Why this matters

  • The authors call for “primordial prevention” of ASCVD by limiting BP increases within normal range, as opposed to delaying to primary prevention once hypertension develops.
  • Editorial endorses the inference from these findings that SBP increases well within normal range can contribute to ASCVD risk.

Key results

  • Overall median (interquartile range) 10-year ASCVD risk was 3.0% (95% CI, 1.1%-6.7%).
  • With SBP
  • With every 10-mmHg SBP increase, the aHR for ASCVD was 1.53 (95% CI, 1.17-1.99).
  • Using SBP 90-99 mmHg as reference, ASCVD risk (aHRs; 95% CIs) by normal SBP ranges:
    • 100-109 mmHg: 3.00 (1.01-8.88).
    • 110-119 mmHg: 3.10 (1.03-9.28).
    • 120-129 mmHg: 4.58 (1.47-14.27).

Study design

  • Cohort study with 1457 participants without ASCVD in the US Multi-Ethnic Study of Atherosclerosis.
  • Participants had normal cholesterol, were nonsmokers, and were not taking antihypertensives at entry.
  • Funding: National Heart, Lung, and Blood Institute; others.

Limitations

  • Did not account for behavioral risk factors.