1. Lowering of SBP by 20 mm Hg Reduces Cardiovascular Risk by Half
2/16/2019 1:58 PM
Lowering of SBP by 20 mm Hg Reduces Cardiovascular Risk by Half
Stroke
IHD
Other vascular causes
-10
N=958,074
-20
40-49
50-59
-30
60-69
% mortality reduction for each 20 mm Hg drop in SBP
-40
Years of age
70-79
-50
Points of Emphasis / Key Messages
In almost all age groups, the risk of CV events is reduced by 35-60% for every SBP in 20 mm Hg. While relative risk of BP lowering in the older patients was lower than for the other age groups, the absolute risk remains clinically important.
SBP is strongly associated with age-specific mortality rates from stroke and almost as strongly associated with age-specific mortality rates from IHD and other vascular causes. These relationships continue, without any evidence of a threshold, down to at least 115/75 mm Hg.
This figure was derived from a meta-analysis of individual participant data from 61 prospective observational studies of BP and mortality that involved nearly 1 million adults with no prior vascular disease. 
The geographic breakdown of participants was as follows: 70% from Europe, 20% from North America or Australia, and the rest from Japan or China. Persons with preexisting vascular disease were excluded from analysis. 
Investigators determined the number of deaths attributed to stroke, ischemic heart disease, other vascular causes, and nonvascular causes during 5 decades of age at risk (from ages 40 to 89), ignoring the few deaths that occurred outside that range. Through meta-analyses, they related mortality during each decade of age at death to the estimated usual BP at the start of that decade.
A 20 mm Hg difference in usual SBP entailed an approximately equivalent hazard as a 10 mm Hg difference in usual DBP. 
Reference
Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to
vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective
studies. Lancet. 2002;360:
80-89
-60
-70
*Data from a meta-analysis of 1 million adults in 61 prospective studies who had no prior vascular disease. Lewington S et al. Lancet. 2002;360: 23
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