Biomarkers · Cardiac & Hemodynamics

Systolic Blood Pressure (SBP)

Both low and high values go with higher risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 8% higher risk of death. We found the same pattern in NHANES

SBP and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.08×95% CI 1.05–1.10 · 49,318 adults, 7,264 deaths

Published risk of death1.78×SBP >=180 mmHg vs 100-119 mmHg (reference) (95% CI 1.12–2.81) · Nationally representative sample of community-dwelling older adults (60-97 y) in Singapore, BP measured 2009, mortality to end-2015

Value of the measurement+0.008gain in concordance within age bands; rank 41 of 56 · all tests

Across studies, risk per SD1.08×NHANES 1.08 [1.05–1.10] · CRELES 0.89 [0.78–1.00] · HRS 1.06 [1.04–1.09]

SBP across cohorts

0.750.80.911.11.25HR per SD (95% CI)

NHANES · United States, 20–8449,318 people · 7,264 deaths1.08 1.05–1.10

CRELES · Costa Rica, 60+2,602 people · 502 deaths0.89 0.78–1.00

HRS · United States, 50+24,148 people · 8,515 deaths1.06 1.04–1.09

CHARLS · China, 50+10,449 people · 1,715 deaths1.17 1.10–1.25

Risk-of-death ratio per standard deviation, adjusted for age and sex, within each cohort. Cohorts differ in age range, assay, measurement protocol and follow-up, and one SD is a different amount in each, so the comparison is of direction and rough size per SD, not per unit. Vertical line: no association.

SBP by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mmHg), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	98.0	106	114	123	137	1,449	NHANES 2017-2018
All	40-59	101	113	123	133	153	1,576	NHANES 2017-2018
All	60+	105	119	130	146	170	1,923	NHANES 2017-2018
All	all	101	111	122	133	158	4,948	NHANES 2017-2018
Men	20-39	103	111	119	127	140	704	NHANES 2017-2018
Men	40-59	103	115	123	133	151	744	NHANES 2017-2018
Men	60+	106	118	129	143	163	980	NHANES 2017-2018
Men	all	103	114	123	133	155	2,428	NHANES 2017-2018
Women	20-39	96.0	104	109	117	133	745	NHANES 2017-2018
Women	40-59	100	111	121	133	155	832	NHANES 2017-2018
Women	60+	105	120	131	149	175	943	NHANES 2017-2018
Women	all	98.0	108	119	133	161	2,520	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in SBP, study by study

7 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
diet	DASH diet (rich in fruits, vegetables, low-fat dairy; reduced saturated and total fat)	DASH combination diet lowered systolic BP by 5.5 mm Hg vs control overall and by 11.4 mm Hg in hypertensive participants (8 weeks)	RCT	Appel LJ, et al. N Engl J Med. 1997;336:1117-1124.
diet	DASH dietary pattern combined with low sodium intake	SBP 7.1 mm Hg lower (without hypertension) and 11.5 mm Hg lower (with hypertension) vs control diet with high sodium	RCT	Sacks FM, et al. N Engl J Med. 2001;344:3-10.
diet	Low-carbohydrate dietary pattern followed for 6 months by adults with overweight or obesity (Atkins-type)	SBP 5.14 mmHg lower than usual diet at six months (moderate certainty), similar to low-fat diets (5.05 mmHg); Atkins -5.1, DASH -4.7, Zone -3.5 mmHg	meta-analysis	Ge L, Sadeghirad B, Ball GDC, et al. BMJ. 2020.
exercise	Isometric resistance training and continuous aerobic endurance training	Resting SBP reduced by 8.24 mm Hg with isometric training and 4.49 mm Hg with aerobic training vs control (270 RCTs)	meta-analysis	Edwards JJ, et al. Br J Sports Med. 2023;57:1317-1326.
exercise	Dynamic (weight-lifting) resistance training programmes of at least 4 weeks in healthy adults	Resting SBP reduced 1.8 mmHg (95% CI 0.011-3.7) and DBP 3.2 mmHg with dynamic resistance training; largest in prehypertensives (-4.0/-3.8 mmHg)	meta-analysis	Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic…
pharmacologic	First-line antihypertensive dual combination (ACEi/ARB + DHP-CCB or Thiazide)	Placebo-subtracted SBP fell 13.9 mm Hg (ACEi) and 14.3 mm Hg (CCB) when combined with a second class vs 6.8 and 8.4 mm Hg alone	meta-analysis	Wald DS, et al. Combination therapy versus monotherapy in reducing blood…
pharmacologic	Once-weekly subcutaneous semaglutide 2.4 mg for 68 weeks in adults with overweight/obesity (pooled STEP trials)	SBP 4.95 mmHg lower than placebo (95% CI 4.05-5.86) at 68 weeks; -4.78 mmHg in those with hypertension, with reduced antihypertensive intensity	meta-analysis	Kennedy C, Hayes P, Cicero AFG, et al. Semaglutide and blood pressure: an…
supplement	Vitamin D3 2000 IU daily for 3 years in community-dwelling adults aged 70+ without major health events (DO-HEALTH)	Difference in 3-year SBP change of -0.8 mmHg (99% CI -2.1 to 0.5; P < .13, not significant) with vitamin D vs no vitamin D; omega-3 1 g/d gave the same -0.8 mmHg	RCT	Bischoff-Ferrari HA, Vellas B, Rizzoli R, et al. Effect of Vitamin D…

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
diet	High sodium intake (>5000 mg/day)	Dose-response: each 100 mmol/24 h difference in urinary sodium shifts SBP by 5.8 mm Hg (2.5 to 9.2); 4.4 g/day less salt lowered SBP 4.18 mm Hg	meta-analysis	He FJ, et al. BMJ. 2013;346:f1325.
pharmacologic	Chronic NSAID usage	NSAIDs raised supine mean BP by 5.0 mm Hg (95% CI 1.2 to 8.7); piroxicam most marked (6.2 mm Hg)	meta-analysis	Johnson AG, et al. Ann Intern Med. 1994;121:289-300.

Sources

Risk curve: Lian 2022 (PMID 34814767): all-cause HR 1.78 (1.12-2.81) SBP >=180 mmHg vs 100-119 mmHg (reference); SBP <100 mmHg: 2.41 (1.23-4.72); SBP 160-179: 1.51 (1.02-2.22). Scaled to US values (NHANES).
Lian et al. Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study. Journal of aging and health. 2022;34:674-683.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Systolic Blood Pressure (SBP) against another biomarker · Featured: Kidney function × blood pressure · Fasting glucose × blood pressure.

Map SBP against another marker