Reassessing normal blood pressure

Atherothrombotic cardiovascular disease is now the leading cause of morbidity and mortality worldwide, with mortality exceeding that for the traditional scourges of infectious diseases, trauma, and malnutrition.1 Evidence suggests that most of the burden of disease is caused by unfavourable levels of several easily identified risk factors: arterial blood pressure, blood lipids, glucose concentrations, body mass index, tobacco use, and physical activity.2

Outcomes can be improved by selective interventions that drive risk factors towards optimum levels, but important questions remain about which risk factors should be treated, in which patients, to what levels, and by what means. The study in this week's BMJ by Conen and colleagues3 helps to answer some of these questions. It compares cardiovascular risk over two years in women with high normal blood pressure (130-139/85-89 mm Hg) to those with normal blood pressure (120-129/75-84 mm Hg) and those with baseline hypertension. It found that women with normal blood pressure had a lower risk of a major cardiovascular event (hazard ratio 0.61, 95% …