CVD Risk Highest Among Patients With Slightly High BP

Individuals with systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels below 140/90 mm Hg face the greatest risk of cardiovascular (CV) disease, according to a recent study.

Studies performed before the year 2000 have shown that most events related to CV disease occurred among US adults with SBP/DBP at or above 140/90 mm Hg. However, new evidence appears to contradict this data, because blood pressure (BP) levels have declined and hypertension control has improved over the past several decades.
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To estimate the incidence of CV events among individuals with SBP/DBP below 140/90 mm Hg, the researchers pooled data from the 2003 to 2007 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n = 31,856); the 2000 to 2002 Multi-Ethnic Study of Atherosclerosis (MESA) (n = 21,208); and the 2000 to 2004 Jackson Heart Study (JHS) (n = 3869). Trained staff measured patients’ BP via standardized methods, and patients self-reported antihypertensive medication use. Mean follow-up lasted 7.7 years.

The researchers defined the primary outcome as incident CV disease, based on the first occurrence of fatal or non-fatal stroke, non-fatal myocardial infarction, fatal coronary heart disease, or heart failure. All events were adjudicated in each study.

Results showed that 2584 participants experienced incident events related to CV disease. Overall, 63% of events occurred in participants whose SBP/DBP was lower than 140/90 mm Hg. Events occurred in 58.4% of participants taking antihypertensive medication, compared with 68.1% of those not taking antihypertensive medication, the researchers noted.

Ultimately, the researchers found that most events occurred in participants with SBP/DBP lower than 140/90 mm Hg: 66.7% of those aged younger than 65 years and 60.3% of those aged 65 years or older; 61.4% of women and 63% of men; and 68% of whites, 59.0% of blacks, 52.7% of Hispanics, and 58.5% of Chinese-Americans.

A total of 76.6% of patients with SBP/DPB 140/90 mm Hg taking antihypertensive medication were eligible for statin treatment. However, only 33.2% of these patients were taking statins. Furthermore, 19.5% of these patients met eligibility criteria for the Systolic Blood Pressure Intervention and may benefit from a target goal of SBP 120 mm Hg, according to the researchers.

“While higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP [lower than] 140/90 mm Hg,” the researchers concluded. “Although absolute risk and cost-effectiveness should be considered, additional CVD risk reduction measures for adults with SBP/DBP [lower than] 140/90 mm Hg at high risk for CVD may be warranted.”

—Christina Vogt

Reference:

Tajeu GS, Booth JN, Colantonio LD, et al. Incident cardiovascular disease among adults with blood pressure < 140/90 mm Hg. Circulation. 2017;136(3). https://doi.org/10.1161/CIRCULATIONAHA.117.027362.