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Blood pressure, C-reactive protein, and risk of future cardiovascular events
Gavin J Blake1, Nader Rifai, Julie E Buring
1Center for Cardiovascular Disease Prevention and the Donald W. Reynolds Center for Cardiovascular Research, Boston, Mass, USA. gblake@mater.ie
Insights
High blood pressure and C-reactive protein (CRP) independently predict cardiovascular events. Combining elevated blood pressure and CRP significantly increases cardiovascular risk, highlighting their additive prognostic value for heart health.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Public Health
Background:
- Emerging evidence links elevated blood pressure to vascular inflammation.
- C-reactive protein (CRP) is a key inflammatory marker associated with cardiovascular disease.
- Understanding the interplay between blood pressure and inflammation is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To investigate the relationship between blood pressure, CRP levels, and the incidence of first cardiovascular events in women.
- To determine if CRP provides incremental prognostic value for cardiovascular events across different blood pressure categories.
- To assess the combined and independent contributions of blood pressure and CRP to cardiovascular risk.
Main Methods:
- Prospective cohort study involving 15,215 women.
- Baseline assessment of blood pressure and C-reactive protein (CRP) levels.
- Follow-up for incident first cardiovascular events over a median of 8.1 years.
- Statistical analyses including cross-sectional and prospective analyses, hazard ratios, and risk factor adjustments.
Main Results:
- A significant positive trend was observed between increasing blood pressure categories and median CRP levels at baseline (P < 0.0001).
- Both elevated CRP levels (≥3 mg/L) and higher blood pressure categories were independent predictors of future cardiovascular events.
- The combination of high blood pressure (≥160/95 mm Hg) and high CRP (≥3 mg/L) was associated with a substantially increased hazard ratio (8.31) for cardiovascular events.
- Risk factor-adjusted analyses showed additive effects: high CRP/low blood pressure (HR 1.87), low CRP/high blood pressure (HR 2.54), and high CRP/high blood pressure (HR 3.27).
Conclusions:
- Blood pressure and CRP are independent determinants of cardiovascular risk.
- The predictive value of blood pressure and CRP for cardiovascular events is additive.
- Measuring both blood pressure and CRP can enhance cardiovascular risk stratification.
Background:
Accumulating data suggest a link between blood pressure and vascular inflammation.
Methods And Results:
We examined the relationship between blood pressure, C-reactive protein (CRP), and incident first cardiovascular events among 15 215 women followed prospectively over a median of 8.1 years. In cross-sectional analyses at baseline, median levels of CRP for women with blood pressure <120/75, 120 to 129/75 to 84, 130 to 139/85 to 89, 140 to 159/90 to 94, and > or =160/95 mm Hg were 0.96, 1.42, 2.20, 2.82, and 3.34 mg/L, respectively (P for trend <0.0001). Increasing categories of blood pressure were significant predictors of CRP levels at baseline. In prospective analyses, both elevated CRP levels (> or =3 mg/L) and increasing categories of blood pressure were independent determinants of future cardiovascular events, and CRP had incremental prognostic value at all levels of blood pressure. The adjusted hazard ratio for women with blood pressure > or =160/95 mm Hg and CRP levels > or =3 mg/L was 8.31 (95% CI, 4.44 to 15.55, P<0.0001) compared with those with blood pressure <120/75 and CRP levels <3 mg/L. After participants had been divided into 4 groups on the basis of CRP levels (<3 or > or =3 mg/L) and blood pressure levels (<130/85 or > or =130/85), the risk factor-adjusted hazard ratios were as follows: low CRP/low blood pressure, 1.0; high CRP/low blood pressure, 1.87 (P=0.002); low CRP/high blood pressure, 2.54 (P<0.0001); and high CRP/high blood pressure, 3.27 (P<0.0001).
Conclusions:
CRP and blood pressure are independent determinants of cardiovascular risk, and their predictive value is additive.
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