Deciding When Blood Pressure Is Too High

  • Robert M. Kaplan

In 1992 Geoffrey Rose published The Strategy of Preventive Medicine [1]. Many consider the book to be one of the most important statements about epidemiology and public health written in the twentieth century. Rose was particularly concerned about disease of the coronary arteries that supply blood to the heart. Doctors describe occlusion of these large arteries as coronary heart disease (CHD) or just coronary disease. Heart attacks typically result from disease within these coronary arteries.

Rose noted that there are systematic relationships between risk factors for heart disease and poor health outcomes. High blood presume is one of the most important risk factors. For example, the relationship between systolic blood pressure (SBP) and both heart attack and stroke become systematically more likely beginning with SBPs above 110 mmHg [2, 3]. More recently, a major study on cholesterol-lowering, known as the Heart Protection Study, demonstrated that lowering LDL cholesterol using...


Systolic Blood Pressure Diastolic Blood Pressure High Blood Pressure Heart Attack Normal Blood Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rose GA. The Strategy of Preventive Medicine. Oxford England; New York: Oxford University Press; 1992.Google Scholar
  2. 2.
    Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. Jan 2001;32(1):280–299.Google Scholar
  3. 3.
    Howard G, Howard VJ. Ethnic disparities in stroke: the scope of the problem. Ethn Dis. Fall 2001;11(4):761–768.Google Scholar
  4. 4.
    MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. Jul 6 2002; 360(9326):7–22.CrossRefGoogle Scholar
  5. 5.
    Marmot MG, Poulter NR. Primary prevention of stroke. Lancet. Feb 8 1992; 339(8789): 344–347.CrossRefGoogle Scholar
  6. 6.
    Rose G, Day S. The population mean predicts the number of deviant individuals. BMJ. Nov 3 1990;301(6759):1031–1034.CrossRefGoogle Scholar
  7. 7.
    Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA. Jun 16 1993;269(23):3015–3023.Google Scholar
  8. 8.
    Schwartz LM, Woloshin S. Changing disease definitions: implications for disease prevalence. Analysis of the Third National Health and Nutrition Examination Survey, 1988–1994. Eff Clin Pract. Mar–Apr 1999;2(2):76–85.Google Scholar
  9. 9.
    Kaplan RM, Wingard DL. Trends in breast cancer incidence, survival, and mortality. Lancet. Aug 12 2000;356(9229):592–593.CrossRefGoogle Scholar
  10. 10.
    Kaplan RM. The Ziggy Theorem – toward an outcomes-focused health psychology. Health Psychol. 1994;13(6):451–460.CrossRefGoogle Scholar
  11. 11.
    Black WC, Welch HG. Screening for disease. AJR Am J Roentgenol. 1997;168(1):3–11.Google Scholar
  12. 12.
    Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. Jul 1997;20(7):1183–1197.Google Scholar
  13. 13.
    Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/ TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998; 279(20):1615–1622.CrossRefGoogle Scholar
  14. 14.
    Persistence of reduction in blood pressure and mortality of participants in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. Apr 8 1988;259(14):2113–2122.Google Scholar
  15. 15.
    Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension. Mar 1995;25(3):305–313.Google Scholar
  16. 16.
    Vallbona C, Pavlik V. Advances in the community control of hypertension: from epidemiology to primary care practice. J Hypertens Suppl. Dec 1992;10(7):S51–57.CrossRefGoogle Scholar
  17. 17.
    Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. Oct 16 2002;288(15):1882–1888.CrossRefGoogle Scholar
  18. 18.
    MacMahon S. Antihypertensive drug treatment: the potential, expected and observed effects on vascular disease. J Hypertens Suppl. Dec 1990;8(7):S239–244.Google Scholar
  19. 19.
    The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med. Jan 25 1993;153(2):154–183.Google Scholar
  20. 20.
    Langer RD. The epidemiology of hypertension control in populations. Clin Exp Hypertens. Oct 1995;17(7):1127–1144.CrossRefGoogle Scholar
  21. 21.
    Luepker RV, Jacobs DR, Jr., Folsom AR, et al. Cardiovascular risk factor change-- 1973-74 to 1980-82: the Minnesota Heart Survey. J Clin Epidemiol. 1988;41(9):825–833.CrossRefGoogle Scholar
  22. 22.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. May 21 2003;289(19):2560–2572.CrossRefGoogle Scholar
  23. 23.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. 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. Dec 14 2002;360(9349):1903–1913.CrossRefGoogle Scholar
  24. 24.
    Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet. Dec 9 2000;356(9246):1955–1964.CrossRefGoogle Scholar
  25. 25.
    Kaplan RM, Ong M. Rationale and Public Health Implications of Changing CHD Risk Factor Definitions. Annu Rev Public Health. 2007;28:321–344.Google Scholar
  26. 26.
    Olsen O, Gøtzsche PC. Cochrane review on screen for breast cancer with mammography. The Lancet. 2001;358(9290).Google Scholar
  27. 27.
    Byington RP, Miller ME, Herrington D, et al. Rationale, design, and baseline characteristics of the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT). Am J Cardiol. Oct 15 1997;80(8):1087–1090.CrossRefGoogle Scholar
  28. 28.
    Wright JT, Jr., Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. Nov 20 2002;288(19):2421–2431.CrossRefGoogle Scholar
  29. 29.
    Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to Type 2 diabetes. N Engl J Med. Sep 20 2001;345(12):851–860.CrossRefGoogle Scholar
  30. 30.
    Estacio RO, Savage S, Nagel NJ, Schrier RW. Baseline characteristics of participants in the Appropriate Blood Pressure Control in Diabetes trial. Control Clin Trials. Jun 1996;17(3):242–257.CrossRefGoogle Scholar
  31. 31.
    Lievre M, Marre M, Chatellier G, et al. The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group. Control Clin Trials. Aug 2000;21(4):383–396.CrossRefGoogle Scholar
  32. 32.
    Marre M, Lievre M, Chatellier G, Mann JF, Passa P, Menard J. Effects of low dose ramipril on cardiovascular and renal outcomes in patients with Type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study). BMJ. Feb 28 2004;328(7438):495.CrossRefGoogle Scholar
  33. 33.
    Bulpitt C, Fletcher A, Beckett N, et al. Hypertension in the very elderly trial (HYVET): protocol for the main trial. Drugs Aging. 2001;18(3):151–164.CrossRefGoogle Scholar
  34. 34.
    Pohl MA, Blumenthal S, Cordonnier DJ, et al. Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations. J Am Soc Nephrol. Oct 2005;16(10):3027–3037.CrossRefGoogle Scholar
  35. 35.
    Rodby RA, Rohde RD, Clarke WR, et al. The Irbesartan Type II diabetic nephropathy trial: study design and baseline patient characteristics. For the Collaborative Study Group. Nephrol Dial Transplant. Apr 2000;15(4):487–497.CrossRefGoogle Scholar
  36. 36.
    Dens JA, Desmet WJ, Coussement P, et al. Usefulness of Nisoldipine for prevention of restenosis after percutaneous transluminal coronary angioplasty (results of the NICOLE study). NIsoldipine in Coronary artery disease in LEuven. Am J Cardiol. Jan 1 2001;87(1):28–33.CrossRefGoogle Scholar
  37. 37.
    Liebson PR, Grandits GA, Dianzumba S, et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation. Feb 1 1995;91(3):698–706.Google Scholar
  38. 38.
    Julius S, Nesbitt SD, Egan BM, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. Apr 20 2006;354(16):1685–1697.CrossRefGoogle Scholar
  39. 39.
    Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. Nov 17 2001;358(9294):1682–1686.CrossRefGoogle Scholar
  40. 40.
    Strauss MH, Hall AS. Angiotensin receptor blockers may increase risk of myocardial infarction: unraveling the ARB-MI paradox. Circulation. Aug 22 2006;114(8):838–854.CrossRefGoogle Scholar
  41. 41.
    Glasziou PP, Irwig LM. An evidence based approach to individualising treatment. BMJ. Nov 18 1995;311(7016):1356–1359.Google Scholar
  42. 42.
    Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004;82(4):661–687.CrossRefGoogle Scholar
  43. 43.
    Schwartz LM, Woloshin S. Changing disease definitions: implications for disease prevalence. Analysis of the Third National Health and Nutrition Examination Survey, 1988–1994. Eff Clin Pract. 1999;2(2):76–85.Google Scholar
  44. 44.
    Mattila K, Haavisto M, Rajala S, Heikinheimo R. Blood pressure and five year survival in the very old. Br Med J (Clin Res Ed). Mar 26 1988;296(6626):887–889.CrossRefGoogle Scholar
  45. 45.
    Langer RD, Ganiats TG, Barrett-Connor E. Factors associated with paradoxical survival at higher blood pressures in the very old. Am J Epidemiol. Jul 1 1991;134(1):29–38.Google Scholar
  46. 46.
    Langer RD, Ganiats TG, Barrett-Connor E. Paradoxical survival of elderly men with high blood pressure. BMJ. May 20 1989;298(6684):1356–1357.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  1. 1.UCLA School of Public HealthLos AngelesUSA

Personalised recommendations