Prevention of Cardiovascular Disease Events and Deaths Among Black Adults Via Systolic Blood Pressure Equity.

Importance: There are disparities in blood pressure (BP) levels by race in the US. Objective: To estimate the number of cardiovascular disease (CVD) events and deaths that could be prevented among non-Hispanic Black adults by achieving the same mean systolic BP (SBP) as non-Hispanic White adults 45 years or older. Design, Setting, and Participants: In this modeling study, the difference in mean SBP between non-Hispanic Black and non-Hispanic White US adults was calculated from the 2015-2020 cycles of the National Health and Nutrition Examination Survey (NHANES). The 10-year cumulative incidence of CVD, including stroke, coronary heart disease, and heart failure, and CVD mortality for non-Hispanic Black adults were calculated using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The relative risk reduction for CVD events and mortality with initiation and intensification of antihypertensive medication treatment was applied from the Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC), calibrated to reflect the SBP reduction for non-Hispanic Black adults to have the same SBP as non-Hispanic White adults. Data were analyzed from June 22, 2022, to August 13, 2025. Exposure: Systolic blood pressure. Main Outcomes and Measures: Number of CVD events and deaths. Using data from NHANES, REGARDS, and BPLTCC, the cumulative incidence of CVD events and deaths expected over the next 10 years with current SBP levels and with SBP equity was estimated. Results: Among 82.3 million US adults included in the study, 37.2 million (45.3%) were men, 45.0 million (54.7%) were women, 10.1 million (12.2%) were non-Hispanic Black, and 72.2 million (87.8%) were non-Hispanic White. The mean (SD) age was 60.8 (0.3) years. The mean SBP was 130.7 (95% CI, 129.0-132.5) mm Hg among non-Hispanic Black adults and 124.2 (95% CI, 123.1-125.3) mm Hg among non-Hispanic White adults for those not taking antihypertensive medication (difference, 6.5 [95% CI, 4.5-8.5] mm Hg), and 137.8 (95% CI, 135.8-139.8) mm Hg among non-Hispanic Black adults and 131.2 (95% CI, 129.7-132.7) mm Hg among non-Hispanic White adults for those taking antihypertensive medication (difference, 6.5 [95% CI, 4.0-9.1] mm Hg). Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD events during 10 years by 50 434 (95% CI, 33 985-71 137) among non-Hispanic Black US adults not taking antihypertensive medication and 122 881 (95% CI, 83 220-176 826) among non-Hispanic Black adults taking antihypertensive medication. Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD deaths during 10 years by 21 703 (95% CI, 7313-40 278) among non-Hispanic Black US adults not taking antihypertensive medication and 55 055 (95% CI, 19 823-99 693) among non-Hispanic Black adults taking antihypertensive medication. The largest proportion of CVD events and deaths prevented were among those aged 45 to 64 years. For example, more than half of CVD events prevented among non-Hispanic Black adults not taking antihypertensive medication (55%) were in that age group. Conclusions and Relevance: The findings of this modeling study suggest that achieving SBP equity between non-Hispanic Black and White adults could substantially reduce the number of CVD events and deaths experienced by non-Hispanic Black US adults. Initiatives to maintain normal BP and achieve BP control for individuals with hypertension could have a substantial impact on health equity in the US.