Fragmented investigation has masked the overall picture for causes of cardiovascular disease (CVD). Among the risk factors for CVD, high blood pressure (BP) is associated with the strongest evidence for causation and it has a high prevalence of exposure. Biologically, normal levels of BP are considerably lower than what has typically been characterized as normal in research and clinical practice. We propose that CVD is primarily caused by a right-sided shift in the population distribution of BP. Our view that BP is the predominant risk factor for CVD is based on conceptual postulates that have been tested in observational investigations and clinical trials. Large cohort studies have demonstrated that high BP is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia, in addition to coronary heart disease and stroke. In multivariate modeling, the presumed attributable risk of high BP for stroke and coronary heart disease has increased steadily with progressive use of lower values for normal BP. Meta-analysis of BP-lowering randomized controlled trials has demonstrated a benefit which is almost identical to that predicted from BP risk relationships in cohort studies. Prevention of age-related increases in BP would, in large part, reduce the vascular consequences usually attributed to aging, and together with intensive treatment of established hypertension would eliminate a large proportion of the population burden of BP-related CVD.

中文翻译：

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高血压和心血管疾病

零散的调查掩盖了心血管疾病 (CVD) 病因的整体情况。在 CVD 的危险因素中，高血压 (BP) 与最强有力的因果关系证据相关，并且暴露率很高。在生物学上，正常的血压水平远低于研究和临床实践中通常被描述为正常的水平。我们认为 CVD 主要是由 BP 人口分布的右移引起的。我们认为 BP 是 CVD 的主要危险因素是基于已经在观察研究和临床试验中检验过的概念假设。大型队列研究表明，高血压是心力衰竭、心房颤动、慢性肾脏病、心脏瓣膜疾病、主动脉综合征、和痴呆症，此外还有冠心病和中风。在多变量模型中，随着逐渐使用较低的正常血压值，卒中和冠心病的高血压的假定归因风险稳步增加。降压随机对照试验的荟萃分析表明，其益处几乎与队列研究中从血压风险关系预测的益处相同。预防与年龄相关的 BP 升高在很大程度上会减少通常归因于衰老的血管后果，并且与已确诊的高血压的强化治疗一起将消除大部分与 BP 相关的 CVD 的人口负担。随着逐渐使用较低的正常血压值，中风和冠心病引起的高血压的推定归因风险稳步增加。降压随机对照试验的荟萃分析表明，其益处几乎与队列研究中从血压风险关系预测的益处相同。预防与年龄相关的 BP 升高在很大程度上会减少通常归因于衰老的血管后果，并且与已确诊的高血压的强化治疗一起将消除大部分与 BP 相关的 CVD 的人口负担。随着逐渐使用较低的正常血压值，中风和冠心病引起的高血压的推定归因风险稳步增加。降压随机对照试验的荟萃分析表明，其益处几乎与队列研究中从血压风险关系预测的益处相同。预防与年龄相关的 BP 升高在很大程度上会减少通常归因于衰老的血管后果，并且与已确诊的高血压的强化治疗一起将消除大部分与 BP 相关的 CVD 的人口负担。