Systolic BP above 90 mm Hg linked to CVD in stepwise increasing fashion: JAMA
Delhi: Even a normal systolic blood pressure (SBP) of 90 mm Hg is not good enough, a recent study in the journal JAMA Cardiology has suggested. According to the study, there appears to be a stepwise increase in the risk of atherosclerotic cardiovascular disease (ASCVD) beginning at an SBP level as low as 90 mm Hg.
Additionally Cardiovascular risk continues to reduce as systolic blood pressure decreases right down to levels as low as 90 mm Hg, a new study has shown.
"These new findings support the position that risk imposed by blood pressure level begins well below the current 130/80 mm Hg definition of hypertension and guideline-recommended goal," Daniel W. Jones, Department of Medicine, University of Mississippi Medical Center, Jackson, suggested in an accompanying editorial.
Seamus P. Whelton, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, and colleagues conducted the study to examine the association of SBP levels with coronary artery calcium an ASCVD in people without hypertension.
"These results highlight the importance of primordial prevention for SBP level increase and other traditional ASCVD risk factors, which generally seem to have similar trajectories of graded increase in risk within values traditionally considered to be normal," wrote the authors.
For the study, the researchers deployed a cohort of 1457 participants free of ASCVD from the Multi-Ethnic Study of Atherosclerosis who were without dyslipidemia (low-density lipoprotein cholesterol level ≥160 mg/dL or high-density lipoprotein cholesterol level <40 mg/dL), diabetes (fasting glucose level ≥126 mg/dL), treatment for hyperlipidemia or diabetes, or current tobacco use, and had an SBP level between 90 and 129 mm Hg. The study excluded the participants receiving hypertension medications.
Coronary artery calcium was classified as absent or present and adjusted hazard ratios (aHRs) were calculated for incident ASCVD. The study was conducted from March 27, 2018, to February 12, 2020.
Key findings of the study include:
- There was an increase in traditional ASCVD risk factors, coronary artery calcium, and incident ASCVD events with increasing SBP levels.
- The aHR for ASCVD was 1.53 for every 10-mm Hg increase in SBP levels.
- Compared with persons with SBP levels 90 to 99 mm Hg, the aHR for ASCVD risk was 3.00 for SBP levels 100 to 109 mm Hg, 3.10 for SBP levels 110 to 119 mm Hg, and 4.58 for SBP levels 120 to 129 mm Hg.
"Beginning at an Systolic Blood Pressure level as low as 90 mm Hg, there appears to be a stepwise increase in the presence of coronary artery calcium and the risk of incident ASCVD with increasing Systolic Blood Pressure levels," concluded the authors.
The study, "Association of Normal Systolic Blood Pressure Level With Cardiovascular Disease in the Absence of Risk Factors," is published in the journal JAMA Cardiology.
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