Prospective data from Western populations show a fairly steady increase in the incidence of total mortality as well as of myocardial infarction (MI) and sudden coronary death (SD) with increasing blood pressure levels. In the age groups up to 70 years, stroke is much less common than MI and SD at virtually all blood pressure levels, but for older men and also for somewhat younger women, stroke is as common as MI and SD at the highest blood pressure levels. The incidence of MI and SD is strongly dependent on serum lipid abnormalities and smoking habits, whereas stroke appears to depend very little on lipid levels and in only a few studies appears related to smoking habits. Thus, the effect of blood pressure is appreciably modified by the presence of some other abnormalities that are believed to enhance coronary arteriosclerosis. There are major differences between populations with respect to the incidence of MI, SD, and stroke. MI mortality and SD have, for example, been very high in the United States, whereas stroke mortality has been low. In Japan, on the other hand, stroke mortality has been high and MI mortality and SD have been low. Sweden has occupied an intermediate position with respect to MI mortality and SD, which have been increasing slightly while they have been decreasing in the United States, whereas stroke mortality in Sweden and in the other Scandinavian countries has been very low and is even showing a slight decrease. Both prospective epidemiologic studies and intervention trials indicate some influence of blood pressure on noncardiovascular mortality, such as that from cancer.
- Copyright © 1984 by American Heart Association