Related Experiment Videos
The relation of blood pressure to coronary heart mortality in different age groups varies by ethnicity
1Department of Medicine, Columbia University, New York, New York 10032, USA.
Insights
Systolic blood pressure (SBP) is a better predictor of coronary heart disease (CHD) mortality in African Americans across all ages. For white individuals, diastolic blood pressure (DBP) is key in younger adults, shifting to SBP in older age groups.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Gerontology
Background:
- Blood pressure indices (pulse pressure, mean arterial pressure, SBP, DBP) predict coronary heart disease (CHD).
- Predictive importance of these indices changes with age in white populations.
- Limited data exist on these relationships in African American populations.
Purpose of the Study:
- To investigate the role of ethnicity in the relationship between blood pressure indices and CHD mortality.
- To compare how different blood pressure measures predict CHD mortality across age groups in white and African American individuals.
Main Methods:
- Utilized a pooled database of eight prospective cohorts (n = 29,829) with 1912 CHD events.
- Employed Cox regression analyses to assess associations between blood pressure indices and CHD mortality.
- Stratified analyses by four age groups (30-39, 40-49, 50-59, ≥60 years) and ethnicity, excluding those on antihypertensive medication.
Main Results:
- Systolic blood pressure (SBP) was the best predictor of CHD mortality in African Americans across all age groups.
- In white subjects, diastolic blood pressure (DBP) was the best predictor for ages 30-39, while SBP became the best predictor for ages 40 and older.
- When both SBP and DBP were considered, SBP was significantly associated with CHD mortality in African Americans of all ages, whereas DBP was only significant in younger white adults.
Conclusions:
- SBP is a more significant predictor of CHD mortality than DBP or pulse pressure in African American subjects across all studied age groups.
- In white subjects, the primary predictor of CHD mortality shifts from DBP in younger adults to SBP in older adults.
- Findings highlight ethnic and age-related differences in the predictive value of blood pressure indices for cardiovascular disease.
Background:
The relative importance of pulse pressure, mean arterial pressure, systolic blood pressure (SBP), and diastolic blood pressure (DBP) as predictors of coronary heart disease (CHD) have been shown to change with aging in individuals of white ethnicity, but few published data exist for those of African American ethnicity.
Methods:
To assess the role of ethnicity in this relationship we compared the association of BP indices to CHD mortality (from a pooled database of eight prospective cohorts, n = 29829, follow-up 13.8 +/- 7.9 years, 1912 events) in the four age groups (30 to 39, 40 to 49, 50 to 59, and > or = 60 years) by the decrease in the -2 log likelihood in Cox regression analyses of subjects who were not receiving antihypertensive drug therapy at baseline.
Results:
All BP indices were significant (P < .05) for all age groups in models containing a single BP index. In white subjects, the best predictor of CHD mortality was DBP for persons 30 to 39 years of age, whereas SBP was the best predictor for persons 40 to 49, 50 to 59 and > or = 60 years of age. In African American subjects, SBP was the best predictor in all age groups. When considered jointly, DBP, but not SBP, was significantly associated with CHD mortality in white subjects 30 to 39 years of age. Only SBP was significant in white subjects 40 to 49, 50 to 59, and > or = 60 years of age. In African Americans, SBP, but not DBP, was associated with CHD mortality in all four age groups when both were in the model.
Conclusion:
In African American subjects, SBP was found to be a better predictor of CHD mortality than DBP or pulse pressure. In white subjects, there was a shift in importance from DBP to SBP as predictors of CHD mortality from the 30 to 39-year age group to the older groups.
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01:17Measurement of Blood Pressure
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