BACKGROUND—: Data from before the 2000s indicate the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP)≥140/90 mmHg. Over the past several decades, BP declined and hypertension control has improved. METHODS—: We estimated the percentage of incident CVD events that occur at SBP/DBP<140/90 mmHg in a pooled analysis of three contemporary US cohorts: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), and the Jackson Heart Study (JHS) (n=31,856; REGARDS=21,208; MESA=6,779; JHS=3,869). Baseline study visits were conducted in 2003-2007 for REGARDS, 2000-2002 for MESA, and 2000-2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or non-fatal stroke, non-fatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study. RESULTS—: Over a mean follow-up of 7.7 years, 2,584 participants had incident CVD events. Overall, 63.0% (95%CI: 54.9%-71.1%) of events occurred in participants with SBP/DBP<140/90 mmHg; 58.4% (95%CI: 47.7%-69.2%) and 68.1% (95%CI: 60.1%-76.0%) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP<140/90 mmHg among those <65 years (66.7%; 95%CI: 60.5%-73.0%) and ≥65 years (60.3%; 95%CI: 51.0%-69.5%), women (61.4%; 95%CI: 49.9%-72.9%) and men (63.8%; 95%CI: 58.4%-69.1%), and for whites (68.7%; 95%CI: 66.1%-71.3%), blacks (59.0%; 95%CI: 49.5%-68.6%), Hispanics (52.7% 95%CI: 45.1%-60.4%) and Chinese-Americans (58.5%; 95%CI: 45.2%-71.8%). Among participants taking antihypertensive medication with SBP/DBP<140/90 mmHg, 76.6% (95% CI: 75.8%-77.5%) were eligible for statin treatment but only 33.2% (95%CI: 32.1%-34.3%) were taking one and 19.5% (95%CI: 18.5%-20.5%) met the Systolic Blood Pressure Intervention Trial eligibility criteria and may benefit from a SBP target goal of 120 mmHg. CONCLUSIONS—: While higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP<140/90 mmHg. Although absolute risk and cost-effectiveness should be considered, additional CVD risk reduction measures for adults with SBP/DBP<140/90 mmHg at high risk for CVD may be warranted.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)