Age-Specific Relevance of Usual Blood Pressure to Vascular Mortality: A Meta-Analysis of 1 Million Adults

This landmark meta-analysis pooled individual data from 61 prospective cohort studies including approximately one million adults to characterize the age-specific relationship between usual blood pressure and vascular mortality — specifically stroke, coronary heart disease, and other vascular causes.

The relationship between usual blood pressure and vascular mortality was continuous, log-linear, and without evidence of a threshold down to at least 115/75 mmHg. The proportional risk of death was consistent across ages 40 through 89 for stroke, ischemic heart disease, and other vascular causes. Importantly, the absolute risk attributable to a given blood pressure level increased with age — the same 20 mmHg difference in systolic blood pressure approximately doubled stroke risk at every decade from 40 to 89.

The no-threshold finding is one of the most consequential in cardiovascular epidemiology. It means that there is no safe blood pressure level below which further reduction confers no benefit — only diminishing returns due to absolute risk reductions at lower baseline pressure. This underpins the rationale for treating blood pressure toward targets well below 140/90 mmHg in high-risk patients, and is consistent with the SPRINT trial finding that systolic targets of 120 mmHg reduced cardiovascular events compared with 140 mmHg.

For the individual patient with a systolic blood pressure of 125 mmHg and other cardiovascular risk factors, this analysis supports addressing blood pressure as part of a comprehensive risk reduction strategy even within the “normal” range.

We rate the evidence strong. A definitive individual-patient meta-analysis establishing the continuous, no-threshold relationship between blood pressure and vascular mortality — foundational evidence for blood pressure treatment targets.