Clinical Edge

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CVD Among Adults with Blood Pressure <140/90 mmHg

Circulation; ePub 2017 Jun 20; Tajeu, Booth, et al

Most incident cardiovascular disease (CVD) events occur in adults with systolic and diastolic blood pressure (SBP/DBP) <140 mmHg, a recent study found. A pooled analysis of 3 contemporary US cohorts estimated the percentage of incident CVD events that occur at SBP/DBP <140/90 mmHg in US adults. The primary outcome was incident CVD, defined by the first occurrence of fatal or non-fatal stroke, non-fatal myocardial infarction, fatal coronary heart disease (CHD), or heart failure. Researchers found:

  • Over a mean follow-up of 7.7 years, 2,584 participants had incident CVD events.
  • 63% of events occurred in participants with SBP/DBP <140/90 mmHg; 58.4% and 68.1% occurred in those taking and not taking antihypertensive medication, respectively.
  • The majority of events occurring in individuals with SBP/DBP <140/90 mmHg were among those aged <65 years (66.7%) and ≥65 years (60.3%), women (61.4%) and men (63.8%), and for whites (68.7%), blacks (59%), Hispanics (52.7%) and Chinese-Americans (58.5%).
  • Among those taking antihypertensive medication with SBP/DBP <140/90 mmHg, 76.6% were eligible for statin treatment but only 33.2% were taking one.


Tajeu GS, Booth JN, Colantonio LD, et al. Incident cardiovascular disease among adults with blood pressure <140/90 mmHg. [Published online ahead of print June 20, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.027362.


This study shows the importance of addressing multiple cardiovascular risk factors in order to optimally decrease the risk for cardiovascular disease. The fact that over half of the CV events were in people under 65 is concerning, suggesting the need for improved attention to CV risk reduction. A question that arises is whether a more rigorous target for BP control, as suggested by the SPRINT trial, would be beneficial.¹ A clear conclusion, given that only a third of eligible patients where on statins, is that control of modifiable risk factors including treatment of hyperlipidemia, smoking cessation, and encouragement of exercise to achieve CV risk reduction is essential. —Neil Skolnik, MD

  1. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-16. doi:10.1056/NEJMoa1511939.