However, in addition to the SPRINT trial, there is support for the new guidelines
that lower the goal for blood pressure to below 140/90. A very large study using
data from 1.3 million adults in an outpatient population found that the risk of CVD
events was highest for systolic hypertension, but both systolic and diastolic hypertension
independently predicted adverse outcomes. An increased risk was found
above either 130/80 mm Hg or 140/90 mm Hg. The study also found evidence of a
J-shaped curve. The study authors concluded that their work supports recent guidelines
that lowered blood pressure targets for high-risk patients.

In most epidemiological studies of hypertension, medically untreated individuals
have a linearly progressive increase in CVD and mortality with higher BP levels,
without any evidence of a J-shaped curve, that is to say, lower, rather than increased
mortality, at very low blood pressure levels. For example, a nine-year prospective
study in China of more than 500,000 adults age 30 to 79 found that each 10 mm Hg
increase in systolic blood was associated with a 30% higher risk of ischemic heart
disease and stroke and an even greater risk of hemorrhagic stroke. Down to a systolic
blood pressure of 120 mm Hg, there was no evidence of a J-shaped curve.246

A 2020 study with an average of 14.5 years of follow-up among 1,457 participants
without CVD published in JAMA Cardiology found that beginning with a systolic
blood pressure level of 90 mm Hg, there was a stepwise increase in the prevalence
of atherosclerotic cardiovascular disease risk factors, including coronary artery calcium,
and the risk of atherosclerotic cardiovascular disease. For every 10-mm Hg
increase in systolic blood pressure, there was a 53% higher risk for atherosclerotic
cardiovascular disease. This study also found no evidence of a J-shaped curve.
These observations have strengthened the argument that the “lower the blood pressure,
the better the outcomes.”

This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel