Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies

Lewington, Sarah; Clarke, Robert; Qizilbash, Nawab; Pető, Richárd; Collins, Rory

doi:10.1016/s0140-6736(02)11911-8

Cited by 8,063 publications

(2,000 citation statements)

References 21 publications

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“…China is less advanced in the epidemiological transition, but because of undertreatment and poor control, the actual population levels are worse for blood pressure and not so different for lipids. Given that hypertension has a stronger association with stroke than with coronary heart disease,2 our findings suggest that hypertension may be responsible for China's high stroke prevalence and it is a much more important cardiovascular risk factor in China than it is in the United States.…”

Section: Discussionmentioning

confidence: 70%

“…One hypothesis is that China's population‐wide risk factor profile is weighted toward stroke rather than coronary heart disease. The question is whether the risk factor profile in China is tilted toward hypertension, which has a stronger link with stroke risk than with coronary heart disease risk,2 rather than, for example, elevated lipid levels, which have stronger associations with coronary heart disease 3. However, there have been no recent studies on direct comparisons of the risk factor profile of China and the United States, a country in which coronary disease is more common than stroke 1.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Pei²,

Zhou

et al. 2018

JAHA

127

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BackgroundThe reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples.Methods and ResultsUsing data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (US National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high‐sensitivity C‐reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3‐ and 7‐fold lower than US rates, respectively. High‐sensitivity C‐reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China.ConclusionsHypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Pei²,

Zhou

et al. 2018

JAHA

127

View full text Add to dashboard Cite

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“…Among blood pressure–related deaths, published estimates suggest that approximately one third of excess CHD and all‐cause mortality can be attributed to elevated systolic blood pressure (SBP) at levels designated as nonhypertensive,6, 7 indicating that benefits achieved from decreases in blood pressure are not limited to populations with hypertension 8, 9, 10, 11, 12. Experimental and observational studies have also demonstrated the efficacy of lifestyle‐based blood pressure interventions, such as increased physical activity and the Dietary Approaches to Stop Hypertension (DASH) diet, for CVD prevention 13, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have estimated the theoretical effects of shifting the distribution of blood pressure, either by lowering the mean population blood pressure or by decreasing the proportion of the population classified as hypertensive 8, 11, 19, 20, 21, 22, 23. Framingham Heart Study investigators reported that a 2‐mm Hg population‐wide diastolic blood pressure (DBP) reduction was associated with an estimated 17% decrease in the prevalence of hypertension, and a 6% reduction in the risk of CHD 19.…”

Section: Introductionmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

156

130

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Background US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.Methods and ResultsWe used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population‐wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987–1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of “428.” A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100 000 person‐years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person‐years, respectively, in whites. In contrast, a 1 mm Hg population‐wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person‐years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population‐wide and targeted interventions.ConclusionsModest population‐wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

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“…US adults <50 years of age meeting the other SPRINT eligibility criteria had a high mean 10‐year CVD risk. Observational studies have demonstrated a strong and graded association between SBP and CVD events beginning as early as age 40 years, and the beneficial effects of antihypertensive medication have been demonstrated in clinical trials of populations with a mean age of 50 years 17, 18, 19, 20. Therefore, antihypertensive medication initiation or titration to an SBP target goal <120 mm Hg may yield a substantial CVD event reduction for high‐risk younger adults.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age <50 Years, Diabetes Mellitus, or a History of Stroke

Bress

Tanner

Hess

et al. 2016

JAHA

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BackgroundAdults <50 years old, with diabetes mellitus, or a history of stroke were not enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Estimating the size and characteristics of these excluded groups who meet the other SPRINT eligibility criteria may provide information on the potential impact of providers extending the SPRINT findings to these populations.Methods and ResultsWe analyzed the National Health and Nutrition Examination Survey 2003–2012 (n=25 076) to estimate the percentage and characteristics of US adults ≥20 years in 3 populations (age <50 years, diabetes mellitus, or history of stroke) excluded from SPRINT who otherwise meet the trial eligibility criteria: age ≥50 years, systolic blood pressure (SBP) 130–180 mm Hg, high cardiovascular disease risk, and not having trial exclusion criteria. Overall, 1.0% (95% CI 0.8–1.3) of US adults age <50 years, 25.4% (95% CI 23.4–27.6) with diabetes mellitus, and 19.0% (95% CI 16.0–22.4) with history of stroke met the other SPRINT eligibility criteria. Among US adults with SBP ≥130 mm Hg, other SPRINT eligibility criteria were met by 7.5% (95% CI 6.1–9.2) of those age <50 years, 32.9% (95% CI 30.5–35.4) with diabetes mellitus, and 23.0% (95% CI 19.4–27.0) with history of stroke. Among US adults meeting the other SPRINT eligibility criteria, antihypertensive medication was being taken by 31.0% (95% CI 23.9–41.3) of those <50 years, 63.0% (95% CI 58.2–67.6) with diabetes mellitus, and 68.9% (95% CI 59.4–77.1) with a history of stroke.ConclusionsA substantial percentage of US adults with diabetes mellitus or history of stroke and a small percentage <50 years old meet the other SPRINT eligibility criteria.

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Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies

Cited by 8,063 publications

References 21 publications

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age <50 Years, Diabetes Mellitus, or a History of Stroke

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