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Blood pressure: a constructed joint reading, not a sourced ACM curve

Each row is one study of death risk from blood pressure. The bright line is what that study found. The band around it is the range the data still supports — it fades where the evidence thins. Left of the centre line is lower risk.

what the study foundstill plausibleno changecould be nothing
Two groups compared
the whole gap between a high and a low
SBP target below 120 vs below 140 mmHg
SPRINT Research Group (Wright et al.) 2015
27% lower
range 10–40% lower
One step at a time
what each single increase is worth
each 10 mmHg lower SBP (treatment trials)
Ettehad et al. 2016
13% lower
range 9–16% lower
each 5 mmHg lower SBP (treatment IPD)
Blood Pressure Lowering Treatment Trialists’ Collaboration (Rahimi et al.) 2021
2% lower
range crosses no change

Heart and stroke death, not all-cause. Ages 40–69. No threshold down to 115/75. Lewington 2002.

Usual systolic blood pressure
ages 40–69
2×
heart & stroke death
each extra 20 mmHg systolic
+20 mmHg systolic
about +10 mmHg diastolic

What it is

Blood pressure is the force of blood against artery walls, recorded as systolic over diastolic (e.g. 120/80 mmHg).

Why it matters for longevity

The engine is a constructed joint rule (120/80 = 1.0; confidence LOW). When both numbers sit at or below that reference it takes the less-favorable of the two small rewards; when either is high it takes the worse penalty (+8% per 10 mmHg SBP or per 5 mmHg DBP). No paper specifies that combination. The overlay is Lewington 2002: ages 40–69, each 20/10 mmHg usual BP ≈ twofold vascular death, down to 115/75 — vascular, not all-cause, and ~2.0 per 20 mmHg is not this calculator’s 1.08 per 10. No matching-construct usual office/home BP → ACM continuous general-population meta was opened. Treatment ACM exists and is a different design: Ettehad RR 0.87 per 10 mmHg SBP reduction; Bundy ACM HR 0.73 at achieved 120–124 vs 130–134; Brunström primary-prevention ACM neutral below baseline 140 (RR 0.98). SPRINT intensive ACM HR 0.73 during the trial; Jaeger: that benefit did not persist after intensity lapsed (8.8 y ACM HR 1.08). Engine not moved.

How to improve it

  • Eat more potassium-rich foods
  • Exercise regularly and practice stress recovery
  • Monitor at home with a validated cuff and work with a clinician if readings stay high

Evidence, by endpoint

EndpointGradeFinding
—METHOD
Joint rule is constructed (120/80 = 1.0)
High-side +8% per 10 mmHg SBP or per 5 mmHg DBP; low-side milder, floor 0.90. Confidence LOW — no paper specifies this min-reward / max-penalty rule. Engine not moved.
Vascular mortalityB
Lewington is vascular ~2.0/20 mmHg, not ACM
Ages 40–69, each 20/10 usual BP ≈ twofold vascular death, down to 115/75. Interpretation says “overall” too; the abstract’s numbers are vascular. No matching usual-BP → ACM continuous meta opened.
All-cause mortality (treated/achieved SBP)A
0.73 is treated achieved SBP, not this cuff (Bundy 2017)
Trial arms at 120–124 vs 130–134: ACM HR 0.73. Brunström: primary-prevention ACM neutral below baseline 140. Jaeger: SPRINT ACM gain faded after intensity lapsed.
All-cause mortalityA
Treating Below 140 Doesn’t Move ACM (Brunström 2018)
Network meta of 74 trials (306,273 people): in primary prevention, all-cause mortality fell with treatment at baseline SBP ≥160 (RR 0.93, 0.87–1.00) and 140–159 (RR 0.87, 0.75–1.00), but was neutral below a baseline of 140 (RR 0.98, 0.90–1.06). Do not read Bundy’s 0.73 as evidence that treating below 140 lowers ACM.
All-cause mortalityA
SPRINT’s ACM Gain Faded (Jaeger 2022)
SPRINT’s extended follow-up: during the active intervention period, intensive control carried ACM HR 0.83 (0.68–1.01), but by a median 8.8 years total follow-up — after intensive control lapsed and the intensive arm’s outpatient SBP drifted from 132.8 back up to 140.4 mmHg — ACM HR was 1.08 (0.94–1.23). A marker, not a durable one-time treatment effect.
All-cause mortalityA
0.87 Per 10 mmHg Treated, Not Usual BP (Ettehad 2016)
Treatment-trial meta of 123 RCTs (613,815 people): every 10 mmHg reduction in treated SBP carried ACM RR 0.87 (0.84–0.91), I² 35%. A treatment slope from randomized trials, not the observational usual-BP relationship this calculator’s curve represents.
All-cause mortalityA
The Trial Behind 0.73 (Wright 2015)
SPRINT randomized 9,361 high-risk adults without diabetes to an SBP target under 120 vs under 140; stopped early at a median 3.26 years. All-cause mortality was lower in the intensive arm, HR 0.73 (0.60–0.90) — the single trial Jaeger’s longer follow-up later found faded once intensive control lapsed.
All-cause mortalityA
ACM Barely Moves Per 5 mmHg Treated (Rahimi 2021)
Individual-participant treatment meta of 48 trials (344,716 people): per 5 mmHg SBP reduction, MACE fell substantially (HR 0.90, 0.88–0.92) but all-cause mortality barely moved (HR 0.98, 0.96–1.01); cardiovascular death fell more (HR 0.95, 0.92–0.99). Treatment lowers cardiovascular events far more reliably than it lowers all-cause death.

What argues against this

Brunström & Carlberg 2018 (network meta-analysis of 74 trials, 306,273 people) is the strongest opposing source: in primary prevention, all-cause mortality fell with treatment when baseline SBP was ≥160 or 140–159, but was statistically neutral below a baseline of 140 (RR 0.98, 0.90–1.06). This undercuts reading Bundy's 0.73 achieved-SBP figure, or Ettehad's 0.87-per-10mmHg treatment slope, as proof that pushing blood pressure lower within the engine's rewarded low range keeps buying all-cause mortality benefit — treatment's mortality payoff looks concentrated in people who started elevated, not in fine-tuning an already-normal reading.

Last reviewed 2 September 2026

Evidence

  1. Lewington et al. (Prospective Studies Collaboration) (2002) — The Lancet
    Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
    View source
  2. Bundy et al. (2017) — JAMA Cardiology
    Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis
    View source
  3. Brunström & Carlberg (2018) — JAMA Internal Medicine
    Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis
    View source
  4. Jaeger et al. (2022) — JAMA Cardiology
    Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control: A Secondary Analysis of a Randomized Clinical Trial
    View source
  5. Ettehad et al. (2016) — The Lancet
    Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis
    View source
  6. SPRINT Research Group (Wright et al.) (2015) — New England Journal of Medicine
    A Randomized Trial of Intensive versus Standard Blood-Pressure Control
    View source
  7. Blood Pressure Lowering Treatment Trialists’ Collaboration (Rahimi et al.) (2021) — The Lancet
    Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis
    View source
  8. Rapsomaniki et al. (2014) — The Lancet
    Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people
    View source
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