Key result
Blood pressure was linearly associated with cardiovascular events, with risk increasing by 100% (95% CI 99-109%, p<0.001) for every 20 mmHg above a systolic blood pressure of 115 mmHg.
Why the study?
Does blood pressure have a linear relationship with cardiovascular events down to very low levels in subjects without prior cardiovascular disease?
Cohort (n=290,606)
Does blood pressure have a linear relationship with cardiovascular events down to very low levels in subjects without prior cardiovascular disease?
Effect estimate: 100% increase per 20 mmHg above SBP 115 mmHg (95% CI 99-109%)
p-value: p=<0.001
Blood pressure exhibits a continuous, linear relationship with cardiovascular risk extending down to SBP <100 and DBP <80 mmHg, challenging the existence of a J-curve phenomenon at very low blood pressures in healthy individuals.
Linear BP-CV risk relationship in untreated subjects without prior CVD supports current targets; leaves open J-curve possibility in treated or high-risk groups.
Background/Introduction: Studies have shown there is a continuous relationship between blood pressure (BP) and cardiovascular events. However, it has been long debated if there is a J-curve phenomenon at a very low blood pressure. Purpose: We performed a population-based study to determine the relationship between BP and cardiovascular events including cardiac death, myocardial infarction, stroke, and heart failure among subjects. Methods: A total of 290,606 subjects who had no previous history of cardiovascular disease and did not receive BP-lowering medical treatment underwent routine health check-up including BP measurements between 2002 and 2003. Study subjects were censored when they died, developed cardiovascular events, or prescribed antihypertensive medications. Result: The mean age of the study population was 53.61±9.34 and male sex accounted for 58.05%. The median BP was 124 (interquartile range 115–136) mmHg and the prevalence of major cardiovascular risk factors was low (current smoker, 23.10%). After a median follow-up of 6.4 years, there were 10,708 cardiovascular events (10-year event rate: 5.77%). Both systolic and diastolic BP was linearly associated with the risk of cardiovascular events. The linear relationship extended down to systolic BP <100 and diastolic BP <80 mmHg, although the slope was less steep at a low BP. The risk of cardiovascular events increased by 100% (95% confidence interval (CI) 99–109%, p<0.001) for every 20 mmHg above SBP of 115 mmHg and by 54% (95% CI 50–57%, p<0.001) for every 10 mmHg above DBP of 75 mmHg.
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Choi et al. (2018) conducted a cohort in No previous history of cardiovascular disease (n=290,606). Blood pressure vs. Lower blood pressure was evaluated on Cardiovascular events including cardiac death, myocardial infarction, stroke, and heart failure (100% increase per 20 mmHg above SBP 115 mmHg, 95% CI 99-109%, p=<0.001). Blood pressure was linearly associated with cardiovascular events, with risk increasing by 100% (95% CI 99-109%, p<0.001) for every 20 mmHg above a systolic blood pressure of 115 mmHg.
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