10.2.3. Blood pressure.

Blood pressure level is associated with an increased risk of stroke, CHD or peripheral vascular disease. The association is observed both in men and in women, at any age. Observational epidemiological data confirm that both systolic (SBP) and diastolic blood pressure (DBP) show a continuous graded independent relationship with risk of stroke and CHD, progressively and linearly from blood pressure levels as low as 115 mmHg systolic and 75 mmHg diastolic upward. For every 20 mmHg systolic or 10 mmHg diastolic increase, there is a doubling of mortality from CHD and stroke. CVD risk is associated to blood pressure values around 130-139/85-89, quite common in European countries and about 2 times higher than the risk associated to blood pressure values < 120/80 mmHg. Even an isolated increase in SBP is associated to increased CVD risk, especially in elderly subjects. A reduction of blood pressure causes a reduction of fatal and non fatal CVD events. The reduction is larger for stroke events, while the reduction of coronary events is less large, but nevertheless statistically and clinically significant.

Lifestyle improvement interventions are associated to significant reductions of both SBP and DPB. Weight control, a reduction of sodium (salt) intake to less than 1,5 g (3,8 g) per day, an increased intake of fruit, vegetables, and an adequate level of physical activity can help to maintain blood pressure levels within the desired range. If the achieved result is still not sufficient, and if the overall CVD risk of the patient is high, a pharmacological treatment must be considered. Desired goals for blood pressure are < 140/90 mmHg in the general population.

For more details and references, see Chapter 5.2.