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Very large observational studies have provided evidence against a ‘J-shaped association’ between systolic blood pressure (SBP) or diastolic blood pressure (DBP) and risk of cardiovascular disease (CVD).1 The log-linear relationship observed in these studies indicates that, within the normal physiological BP range, there is no threshold below which associations change qualitatively. In order to mitigate the risk of confounding and reverse causality, these studies appropriately excluded people with known CVD. However, this selection has contributed to continued controversy over possible thresholds, particularly among those with established coronary heart disease (CHD); over 20 …
Funding National Institute for Health Research, NIHR Oxford BRC.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.