Physicians' Academy for Cardiovascular Education

Risk of ASCVD gradually increases with increasing SBP levels starting from 90 mmHg

Association of Normal Systolic Blood Pressure Level With Cardiovascular Disease in the Absence of Risk Factors

Literature - Whelton SP, McEvoy JW, Shaw L et al. - JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.1731

Introduction and methods

Many individuals with low traditional atherosclerotic cardiovascular disease (ASCVD) risk factors have subclinical atherosclerosis. Which is measured by the presence of coronary artery calcium (CAC) [1-3]. Individuals with lower exposure to ASCVD risk factors such as high SBP levels during their lifetime have a lower probable risk for future ASCVD events [4-6]. However, it is still uncertain whether the relationship between SBP level and risk for ASCVD also applies to individuals without hypertension or other ASCVD risk factors. Moreover, it remains unresolved whether risk for incident ASCVD plateaus or increases (eg. A J-point) at low SBP levels [7-10].

The present study evaluated the association between SBP and prevalence of CAC as well as incident ASCVD in individuals with SBP levels between 90 and 129 mmHg. A total of 1457 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort [11] who had normal SBP levels (90-129 mm Hg), a baseline coronary artery calcium scan and no prior history of ASCVDs were included in the study. Individuals with hypertension (SBP >129 mm Hg) or hypotension (SBP<90 mm Hg), dyslipidemia (LDL-c level ≥160 mg/dL or HDL-c level <40 mg/dL), diabetes, who were smokers, or used prescribed cholesterol-lowering or blood glucose-lowering medication were excluded. Average (SD) follow-up was 14.5 (3.9) years. Participants were categorized into 4 groups based on their baseline SBP levels: 90-99 mmHg (n=208), 100-109 mmHg (n=414), 110-119 mmHg (n=504), 120-129 (n=331) mmHg. CAC was measured and classified as absent or present and diffuse CAC was defined as presence of CAC in 2 or more coronary arteries. Incident ASCVD was defined as fatal or nonfatal incident coronary heart disease, incident stroke, or other incident ASCVD.

Main results


Presence of CAC and risk of incident ASCVD events increased stepwise with increasing SBP levels in individuals with a SBP between 90 and 129 mmHg who had no other traditional ASCVD risk factors.


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Find this article online at JAMA Cardiol.

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