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Effect of age on blood pressure parameters and risk of cardiovascular death in men
Thomas S Bowman1, Howard D Sesso, J Michael Gaziano
1Veterans Affairs Boston Healthcare System, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, MA, USA. tsbowman@partners.org
Insights
Systolic blood pressure is the most reliable predictor of cardiovascular disease death across all adult ages. Diastolic blood pressure showed a weaker association with risk, supporting continued focus on systolic measurements for cardiovascular risk assessment.
Area of Science:
- Cardiology
- Epidemiology
- Preventive Medicine
Background:
- Elevated blood pressure (BP) is a significant risk factor for cardiovascular disease (CVD).
- Identifying the most effective BP parameter for predicting CVD death is crucial for risk stratification.
- Previous research has yielded unclear results regarding the predictive value of different BP components.
Purpose of the Study:
- To determine which blood pressure parameters best predict cardiovascular disease death.
- To evaluate the predictive importance of systolic BP, diastolic BP, pulse pressure, and mean arterial pressure.
- To assess these predictors across a wide range of adult ages.
Main Methods:
- Prospective cohort study of 53,163 men from the Physicians' Health Study.
- Median follow-up of 5.7 years for cause-specific mortality.
- Cox proportional hazard models were used to calculate relative risks (RRs), adjusting for CVD risk factors and stratifying by age groups.
Main Results:
- Systolic blood pressure (SBP) demonstrated consistent and significant prediction of CVD death across all age groups.
- Diastolic blood pressure (DBP) showed a less consistent association with CVD mortality compared to SBP.
- Pulse pressure and mean arterial pressure were not consistent predictors; combining SBP with other parameters did not enhance predictive accuracy.
Conclusions:
- Systolic blood pressure is the most robust predictor of cardiovascular disease mortality in healthy men, irrespective of age.
- The findings support the continued emphasis on systolic blood pressure measurement for cardiovascular risk assessment.
- Diastolic blood pressure is a less reliable indicator of CVD death risk compared to systolic blood pressure.
Background:
Elevated blood pressure (BP) is a risk factor for cardiovascular disease (CVD), but it remains unclear which component-alone or in combination-is the best predictor. We sought to determine which BP parameters are important predictors of CVD death across a wide age range.
Methods:
We used a prospective cohort study design with 53,163 men followed for cause-specific death during a median of 5.7 years in the Physicians' Health Study enrollment cohort. Baseline age, systolic BP and diastolic BP were collected. We calculated relative risks (RRs) and their 95% confidence intervals using Cox proportional hazard models adjusting for major risk factors for CVD, and then stratified by age (39 to 49, 50 to 59, 60 to 69, and 70 to 84 years).
Results:
There were 459 CVD deaths during follow-up. For each 10 mm Hg increase in systolic BP, the multivariable RRs by ascending age group were 1.46, 1.43, 1.24, and 1.13. The multivariable RRs for each 10 mm Hg increase in diastolic BP were 1.25, 1.20, 1.28, and 1.07. Compared with systolic BP, pulse pressure and mean arterial pressure were not consistent predictors across age ranges, and combining systolic BP with another parameter did not improve the model compared with using systolic BP alone in any age group (all P > .05).
Conclusions:
In this large cohort of healthy men with no history of hypertension, systolic BP was the most consistent and significant predictor of CVD death across all ages. Diastolic BP was not as strongly associated with risk. Our results support the continuing emphasis on using systolic BP in predicting cardiovascular risk.
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