Elevated systolic blood pressure and risk of cardiovascular and renal disease: Overview of evidence from observational epidemiologic studies and randomized controlled trials
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Abstract
The effect of elevated blood pressure on risk of cardiovascular and renal disease
has been documented in both observational epidemiologic studies and clinical trials.
However, these studies have traditionally concentrated on diastolic blood pressure
to characterize the risk associated with hypertension. We reviewed evidence from prospective
studies and randomized controlled trials to quantify the risk associated with systolic
blood pressure. Prospective studies and randomized controlled clinical trials that
were published in English-language journals were retrieved using MEDLINE, bibliographies,
and the authors' reference files. All retrieved publications were reviewed and information
on sample size, duration, study design, antihypertensive medication, participant characteristics,
and outcomes was abstracted for randomized controlled trials that reported systolic
blood pressure reduction during intervention. Several prospective studies indicate
that the association between systolic blood pressure and risk of coronary heart disease,
stroke, and end-stage renal disease is continuous, graded, and independent. Furthermore,
they suggest that the association of systolic blood pressure with these outcomes is
stronger than that of diastolic blood pressure. Pooling of the data available from
randomized controlled trials indicates that an average reduction of 12 to 13 mm Hg
in systolic blood pressure over 4 years of follow-up is associated with a 21% reduction
in coronary heart disease, 37% reduction in stroke, 25% reduction in total cardiovascular
mortality, and 13% reduction in all-cause mortality rates. These data indicate that
systolic blood pressure is an independent and strong predictor for risk of cardiovascular
and renal disease.