The impact of high blood pressure on cardiovascular end points varies, with different effects for high systolic and diastolic blood pressure, according to a study published in The Lancet.

Eleni Rapsomaniki, Ph.D., from the Farr Institute of Health Informatics Research in London, and colleagues used linked electronic health records from 1997 to 2010 for a cohort of 1.25 million patients to examine the associations of blood pressure with 12 different presentations of cardiovascular disease. Participants were aged 30 years or older, and were initially free from cardiovascular disease.

During 5.2 years median follow-up, the researchers identified 83,098 cardiovascular disease presentations. The risk for cardiovascular disease was lowest for people with systolic blood pressure of 90 to 114 mm Hg and diastolic blood pressure of 60 to 74 mm Hg, in each age group.

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There was no evidence of a J-shaped increased risk at lower blood pressure. The impact of high blood pressure varied by cardiovascular disease end point, with the strongest associations seen for intracerebral hemorrhage, subarachnoid hemorrhage, and stable angina (hazard ratios, 1.44, 1.43, and 1.41, respectively), and the weakest association for aortic aneurysm (hazard ratio, 1.08).

Raised systolic blood pressure had a greater impact on angina, myocardial infarction, and peripheral arterial disease, while raised diastolic blood pressure had a greater impact on abdominal aortic aneurysm.

“The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study,” the authors write.