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      High Blood Pressure and Cardiovascular Disease

      1 , 2
      Hypertension
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Fragmented investigation has masked the overall picture for causes of cardiovascular disease (CVD). Among the risk factors for CVD, high blood pressure (BP) is associated with the strongest evidence for causation and it has a high prevalence of exposure. Biologically, normal levels of BP are considerably lower than what has typically been characterized as normal in research and clinical practice. We propose that CVD is primarily caused by a right-sided shift in the population distribution of BP. Our view that BP is the predominant risk factor for CVD is based on conceptual postulates that have been tested in observational investigations and clinical trials. Large cohort studies have demonstrated that high BP is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia, in addition to coronary heart disease and stroke. In multivariate modeling, the presumed attributable risk of high BP for stroke and coronary heart disease has increased steadily with progressive use of lower values for normal BP. Meta-analysis of BP-lowering randomized controlled trials has demonstrated a benefit which is almost identical to that predicted from BP risk relationships in cohort studies. Prevention of age-related increases in BP would, in large part, reduce the vascular consequences usually attributed to aging, and together with intensive treatment of established hypertension would eliminate a large proportion of the population burden of BP-related CVD.

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          Author and article information

          Journal
          Hypertension
          Hypertension
          Ovid Technologies (Wolters Kluwer Health)
          0194-911X
          1524-4563
          February 2020
          February 2020
          : 75
          : 2
          : 285-292
          Affiliations
          [1 ]From the Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (F.D.F.)
          [2 ]Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.).
          Article
          10.1161/HYPERTENSIONAHA.119.14240
          31865786
          02cdf0ab-be4a-4cc9-8aa2-b4eefa921e8a
          © 2020
          History

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