Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality Vascular mortality: Age-specific hazard ratios for 20 mmHg lower usual SBP 55 345 deaths at ages 40-89 No. of deaths 414 0·36 (0·32-0·40) 1372 0·38 (0·35-0·40) 2939 0·43 (0·41-0·45) 4327 0·50 (0·48-0·52) 2636 0·67 (0·63-0·71) 1322 0·49 (0·45-0·53) 5594 0·50 (0·49-0·52) 10 450 0·54 (0·53-0·55) 10 852 0·60 (0·58-0·61) 5649 0·67 (0·64-0·70) Cause of death Stroke IHD Other vascular 386 0·43 (0·38-0·48) 1377 0·50 (0·47-0·54) 2549 0·53 (0·51-0·56) 3227 0·64 (0·61-0·67) Age at risk 40-49 50-59 60-69 70-79 80-89 2251 0·70 (0·65-0·75) 0·25 0·35 0·5 0·7 1·0 Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP Figure 1a: Stroke, IHD and other vascular mortality: Age-specific hazard ratios for given differences in usual SBP. The values plotted are the hazard ratios in each decade of age associated with 20 mmHg lower usual SBPat the start of that decade. Each square has area inversely proportional to the effective variance of the log hazard ratio, with the vertical broken line indicating a hazard ratio of 0·5. In parallel analyses of the large MRFIT study, a 20 mmHg lower usual SBP at the start of the decade for deaths at ages 40-49, 50-59 & 60-69 respectively was associated with hazard ratios (& 95% CIs) of (i) stroke: 0·30 (0·23-0·40), 0·33 (0·29-0·38) & 0·35 (0·31-0·40); (ii) IHD: 0·42 (0·38-0·47), 0·44 (0·42-0·46) & 0·46 (0·44-0·48); and (iii) other vascular: 0·35 (0·30-0·42), 0·42 (0·39-0·46) & 0·44 (0·41-0·48). 1 December 02 Lancet 2002; 360:1903-13

Hazard ratio (& 95% CI) for 10 mmHg lower usual diastolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality Vascular mortality: Age-specific hazard ratios for 10 mmHg lower usual DBP (³ 75 mmHg) 49 120 deaths at ages 40-89 ³ No. of deaths 348 1243 2626 3915 2340 1114 4945 9289 9727 5068 Cause of death Stroke IHD Other vascular 316 1140 2220 2853 Age at risk 40-49 50-59 60-69 70-79 80-89 1976 0·35 (0·30-0·40) 0·34 (0·32-0·37) 0·40 (0·38-0·42) 0·48 (0·45-0·51) 0·63 (0·58-0·69) 0·47 (0·43-0·51) 0·52 (0·50-0·55) 0·56 (0·54-0·58) 0·62 (0·60-0·64) 0·70 (0·65-0·74) 0·43 (0·37-0·50) 0·48 (0·44-0·52) 0·49 (0·46-0·53) 0·61 (0·57-0·66) 0·71 (0·64-0·79) 0·25 0·35 0·5 0·7 1·0 Hazard ratio (& 95% CI) for 10 mmHg lower usual diastolic BP Figure 1b: Stroke, IHD and other vascular mortality: Age-specific hazard ratios for given differences in usual DBP. The values plotted are the hazard ratios in each decade of age associated with 10 mmHg lower usual DBP at the start of that decade. Each square has area inversely proportional to the effective variance of the log hazard ratio, with the vertical broken line indicating a hazard ratio of 0·5. 2 December 02 Lancet 2002; 360:1903-13

(floating absolute risks & 95% CI) PSC: Age-specific relevance of usual blood pressure to vascular mortality Stroke mortality rate in each decade of age versus usual SBP at the start of that decade 11 274 deaths at ages 50 - 89 Age at risk: 20 mmHg  SBP 80-89 33%  risk 70-79 50%  risk 60-69 57%  risk 50-59 62%  risk (40-49 64%  risk) Usual systolic blood pressure (mmHg) (floating absolute risks & 95% CI) Stroke mortality 120 140 160 180 1 2 4 8 16 32 64 128 256 Figure 2a: Stroke mortality rate in each decade of age versus usual SBP at the start of that decade. Rates are plotted on a floating absolute scale, and each square has area inversely proportional to the effective variance of the log mortality rate. 3 December 02 Lancet 2002; 360:1903-13

(floating absolute risks & 95% CI) PSC: Age-specific relevance of usual blood pressure to vascular mortality Stroke mortality rate in each decade of age versus usual DBP at the start of that decade 11 274 deaths at ages 50 - 89 Age at risk: 10 mmHg  SBP 80-89 37%  risk 70-79 52%  risk 60-69 60%  risk 50-59 66%  risk (40-49 65%  risk) 70 80 90 100 110 1 2 4 8 16 32 64 128 256 (floating absolute risks & 95% CI) Stroke mortality Figure 2b: Stroke mortality rate in each decade of age versus usual DBP at the start of that decade. Rates are plotted on a floating absolute scale, and each square has area inversely proportional to the effective variance of the log mortality rate. For DBP, each age-specific regression line ignores the left-hand point (i.e. at slightly less than 75 mmHg), for which the risk lies significantly above the fitted line (as indicated by the broken line below 75 mmHg). Usual diastolic blood pressure (mmHg) 4 December 02 Lancet 2002; 360:1903-13

Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality Stroke mortality: Age- and sex-specific hazard ratios for 20 mmHg lower usual SBP 11 688 deaths at ages 40-89 Sex No. of deaths 40-49 Male 279 0·33 (0·29-0·38) Female 135 0·41 (0·34-0·49) Both 414 0·36 (0·32-0·40) 50-59 989 0·34 (0·32-0·37) 383 0·45 (0·40-0·50) 1372 0·38 (0·35-0·40) 60-69 2116 0·41 (0·39-0·44) 823 0·47 (0·43-0·51) 2939 0·43 (0·41-0·45) 70-79 2599 0·48 (0·46-0·51) 1728 0·53 (0·49-0·56) 4327 0·50 (0·48-0·52) 80-89 1238 0·68 (0·63-0·75) 1398 0·65 (0·60-0·71) 2636 0·67 (0·63-0·71) 0·25 0·35 0·5 0·7 1·0 Age at risk Figure 3a: Stroke mortality: Sex-specific hazard ratios for 20 mmHg lower usual SBP. Conventions as in Figure 1a. Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP 5 December 02 xif.ctrl: 22-MAY-2002 15:16:20.58 Lancet 2002; 360:1903-13

Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality Stroke mortality (by sub-type): Age-specific hazard ratios for 20 mmHg lower usual SBP 11 688 deaths at ages 40-89 0·44 (0·36-0·53) 0·31 (0·26-0·38) 0·44 (0·31-0·64) 0·29 (0·22-0·39) 0·36 (0·32-0·40) 0·50 (0·43-0·58) 0·38 (0·34-0·43) 0·35 (0·29-0·41) 0·34 (0·30-0·38) 0·38 (0·35-0·40) 0·47 (0·40-0·55) 0·43 (0·39-0·47) 0·45 (0·41-0·51) 0·44 (0·41-0·47) 0·43 (0·41-0·45) 0·76 (0·58-0·99) 0·51 (0·47-0·56) 0·50 (0·45-0·55) 0·49 (0·46-0·52) 0·50 (0·48-0·52) Age at risk 40-49 50-59 60-69 70-79 80-89 1·03 (0·56-1·89) 0·51 (0·43-0·60) 0·77 (0·67-0·87) 0·67 (0·62-0·72) Type of stroke S.A.H. C. Haem C. Isch Unknown Any strokes No. of deaths 150 157 46 61 414 301 462 177 432 1372 271 741 538 1389 2939 107 915 850 2455 4327 33 423 518 1662 2636 0·67 (0·63-0·71) 0·25 0·35 0·5 0·7 1·0 Figure 3b: Type-specific stroke mortality: hazard ratios for 20 mmHg lower usual SBP. Conventions as in Figure 1a. Hazard ratios (& 95% CIs) for subarachnoid haemorrhage (SAH) are given numerically but are not plotted. Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP 6 December 02 Lancet 2002; 360:1903-13

(floating absolute risks & 95% CI) PSC: Age-specific relevance of usual blood pressure to vascular mortality IHD mortality rate in each decade of age versus usual SBP at the start of that decade 33 867 deaths at ages 40 - 89 Age at risk 20 mmHg  SBP 80-89 31%  risk 70-79 40%  risk 60-69 46%  risk 50-59 50%  risk 40-49 51%  risk Usual systolic blood pressure (mmHg) 120 140 160 180 1 2 4 8 16 32 64 128 256 (floating absolute risks & 95% CI) IHD mortality Figure 4a: IHD mortality rate in each decade of age versus usual SBP at the start of that decade. Conventions as in Figure 2a. 7 December 02 Lancet 2002; 360:1903-13

(floating absolute risks & 95% CI) PSC: Age-specific relevance of usual blood pressure to vascular mortality IHD mortality rate in each decade of age versus usual DBP at the start of that decade 33 867 deaths at ages 40 - 89 Age at risk 10 mmHg  DBP 80-89 30%  risk 70-79 38%  risk 60-69 44%  risk 50-59 48%  risk 40-49 53%  risk Usual diastolic blood pressure (mmHg) 70 80 90 100 110 1 2 4 8 16 32 64 128 256 (floating absolute risks & 95% CI) IHD mortality Figure 4b: IHD mortality rate in each decade of age versus usual DBP at the start of that decade. Conventions as in Figure 2b. 8 December 02 Lancet 2002; 360:1903-13

Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality IHD mortality: Age- and sex-specific hazard ratios for 20 mmHg lower usual SBP 33 867 deaths at ages 40-89 Age at risk Sex No. of deaths 40-49 Male 1202 0·50 (0·46-0·54) Female 120 0·40 (0·32-0·49) Both 1322 0·49 (0·45-0·53) 50-59 5027 0·50 (0·49-0·52) 567 0·49 (0·45-0·54) 5594 60-69 8609 0·55 (0·54-0·57) 1841 0·50 (0·47-0·53) 10 450 0·54 (0·53-0·55) 70-79 7384 0·62 (0·60-0·64) 3468 0·55 (0·53-0·58) 10 852 0·60 (0·58-0·61) 80-89 2932 0·69 (0·65-0·73) 2717 0·64 (0·60-0·68) 5649 0·67 (0·64-0·70) 0·25 0·35 0·5 0·7 1·0 Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP Figure 5: IHD mortality: Sex-specific hazard ratios for 20 mmHg lower usual SBP. Conventions as in Figure 1a. 9 December 02 xif.ctrl: 22-MAY-2002 15:16:20.58 Lancet 2002; 360:1903-13

PSC: Age-specific relevance of usual blood pressure to vascular mortality Other vascular mortality rate in each decade of age versus usual SBP at the start of that decade 9790 deaths at ages 50-89 Usual systolic blood pressure (mmHg) 120 140 160 180 32 1 2 4 8 16 64 128 256 Other vascular mortality (not stroke or IHD) (floating absolute risks & 95% CI) Age at risk: 20 mmHg  SBP 80-89 30%  risk 70-79 36%  risk 60-69 47%  risk 50-59 50%  risk (40-49 57%  risk) Figure 6a: Other vascular (not stroke or IHD) mortality rate in each decade of age versus usual SBP at the start of that decade. Conventions as in Figure 2a. 10 December 02 Lancet 2002; 360:1903-13

PSC: Age-specific relevance of usual blood pressure to vascular mortality Other vascular mortality rate in each decade of age versus usual DBP at the start of that decade 9790 deaths at ages 50-89 Usual diastolic blood pressure (mmHg) 70 80 90 100 110 1 2 4 8 16 32 64 128 256 Other vascular mortality (not stroke or IHD) (floating absolute risks & 95% CI) Age at risk: 10 mmHg  DBP 80-89 29%  risk 70-79 39%  risk 60-69 51%  risk 50-59 52%  risk (40-49 57%  risk) Figure 6b: Other vascular (not stroke or IHD) mortality rate in each decade of age versus usual DBP at the start of that decade. Conventions as in Figure 2b. 11 December 02 Lancet 2002; 360:1903-13

Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP PSC: Age-specific relevance of usual blood pressure to vascular mortality Mortality from other vascular causes (not stroke or IHD): Hazard ratios for 20 mmHg lower usual SBP 9 790 deaths at ages 40-89 Cause of Mean age No. of death at death deaths Heart Failure 68 746 0·53 (0·48-0·59) Aortic Aneurysm 68 705 0·55 (0·49-0·62) Hypertensive HD 68 649 0·22 (0·20-0·25) Atherosclerosis 72 508 0·48 (0·42-0·55) Sudden death 60 553 0·49 (0·43-0·56) Inflammatory HD 67 320 0·63 (0·53-0·75) Rheumatic HD 64 255 0·74 (0·61-0·89) Other HD (excl. IHD) 69 1682 0·62 (0·58-0·67) Pulmonary embolism 67 296 0·72 (0·60-0·87) Figure 7: Mortality from other vascular causes (not stroke or IHD): Hazard ratios for 20 mmHg lower usual SBP. Conventions as in Figure 1a. Only 54 of the studies subdivided these other vascular causes (Table A1 in Annex A). Other circulatory 65 182 0·56 (0·44-0·71) 0·25 0·35 0·5 0·7 1·0 Hazard ratio (& 95% CI) for 20 mmHg lower usual systolic BP 12 December 02 Lancet 2002; 360:1903-13

(floating absolute risks & 95% CI) PSC: Age-specific relevance of usual blood pressure to vascular mortality IHD mortality rate in each decade of age versus usual mid blood pressure at the start of that decade 33 867 deaths at ages 40 - 89 100 110 120 130 140 150 1 2 4 8 16 32 64 128 256 Usual mid blood pressure (mmHg) (floating absolute risks & 95% CI) IHD mortality Figure 4a: IHD mortality rate in each decade of age versus usual SBP at the start of that decade. Conventions as in Figure 2a. 13 December 02 Lancet 2002; 360:1903-13