Journal Article

Effects of elevated systolic blood pressure on ischemic heart disease: a Burden of Proof study

Wang, Nelson, Sorensen, Reed J. D., Roth, Gregory A., Razo, Christian, Johnson, Catherine O., McLaughlin, Susan A., LeGrand, Kate E., Hay, Simon I., Zheng, Peng, Murray, Christopher J. L., He, Jiawei, Rodgers, Anthony, Iannucci, Vincent, Aravkin, Aleksandr Y., Welgan, Catherine A.

2022

Overview

High systolic blood pressure (SBP) is a major risk factor for ischemic heart disease (IHD), the leading cause of death worldwide. Using data from published observational studies and controlled trials, we estimated the mean SBP–IHD dose–response function and burden of proof risk function (BPRF), and we calculated a risk outcome score (ROS) and corresponding star rating (one to five). We found a very strong, significant harmful effect of SBP on IHD, with a mean risk—relative to that at 100 mm Hg SBP—of 1.39 (95% uncertainty interval including between-study heterogeneity 1.34–1.44) at 120 mm Hg, 1.81 (1.70–1.93) at 130 mm Hg and 4.48 (3.81–5.26) at 165 mm Hg. The conservative BPRF measure indicated that SBP exposure between 107.5 and 165.0 mm Hg raised risk by 101.36% on average, yielding a ROS of 0.70 and star rating of five. Our analysis shows that IHD risk was already increasing at 120 mm Hg SBP, rising steadily up to 165 mm Hg and increasing less steeply above that point. Our study endorses the need to prioritize and strengthen strategies for screening, to raise awareness of the need for timely diagnosis and treatment of hypertension and to increase the resources allocated for understanding primordial prevention of elevated blood pressure. A systematic review using the burden of proof meta-analytic method found a significant harmful effect between high systolic blood pressure and ischemic heart disease.

• Publisher: Nature Publishing Group US,Nature Publishing Group
• Subject: 692/499 / 692/699/75 / Antihypertensive Agents - pharmacology / Antihypertensive Agents - therapeutic use / Biomedical and Life Sciences / Biomedicine / Blood Pressure / Cancer Research / Cardiovascular disease / Cardiovascular diseases / Coronary artery disease / Heart diseases / Heterogeneity / Humans / Hypertension / Hypertension - drug therapy / Infectious Diseases / Ischemia / Metabolic Diseases / Molecular Medicine / Myocardial Ischemia - drug therapy / Myocardial Ischemia - epidemiology / Neurosciences / Observational studies / Reactive Oxygen Species / Response functions / Risk analysis / Risk factors