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Using data from published observational studies and controlled trials, we estimated the mean SBP\u2013IHD dose\u2013response function and burden of proof risk function (BPRF), and we calculated a risk outcome score (ROS) and corresponding star rating (one to five). We found a very strong, significant harmful effect of SBP on IHD, with a mean risk\u2014relative to that at 100\u2009mm Hg SBP\u2014of 1.39 (95% uncertainty interval including between-study heterogeneity 1.34\u20131.44) at 120\u2009mm Hg, 1.81 (1.70\u20131.93) at 130\u2009mm Hg and 4.48 (3.81\u20135.26) at 165\u2009mm Hg. The conservative BPRF measure indicated that SBP exposure between 107.5 and 165.0\u2009mm Hg raised risk by 101.36% on average, yielding a ROS of 0.70 and star rating of five. Our analysis shows that IHD risk was already increasing at 120\u2009mm Hg SBP, rising steadily up to 165\u2009mm Hg and increasing less steeply above that point. Our study endorses the need to prioritize and strengthen strategies for screening, to raise awareness of the need for timely diagnosis and treatment of hypertension and to increase the resources allocated for understanding primordial prevention of elevated blood pressure.<\/jats:p>","DOI":"10.1038\/s41591-022-01974-1","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T16:04:06Z","timestamp":1665417846000},"page":"2056-2065","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":107,"title":["Effects of elevated systolic blood pressure on ischemic heart disease: a Burden of Proof study"],"prefix":"10.1038","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0098-9563","authenticated-orcid":false,"given":"Christian","family":"Razo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4310-1632","authenticated-orcid":false,"given":"Catherine A.","family":"Welgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine O.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Iannucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Rodgers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2690-3198","authenticated-orcid":false,"given":"Kate E.","family":"LeGrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reed J. 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