Related Experiment Videos
Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease: A
Larry J Brant1, Luigi Ferrucci, Shan L Sheng
1Research Resources Branch, National Institute on Aging, Baltimore, Maryland, USA.
Insights
Blood pressure indices predict coronary heart disease (CHD) differently in women and men. Pulse pressure and systolic blood pressure are better predictors in women, while mean arterial pressure and diastolic blood pressure are better in men.
Area of Science:
- Cardiovascular epidemiology
- Biostatistics
- Gerontology
Background:
- Previous studies on blood pressure (BP) indices for coronary heart disease (CHD) prediction yielded inconsistent results.
- Existing models often rely on Cox regression, with age and sex being primary predictors.
Purpose of the Study:
- To investigate age- and gender-related differences in BP indices for predicting CHD using serial BP measurements.
- To enhance CHD risk prediction by examining time-dependent BP indices.
Main Methods:
- Utilized mixed-effects regression and posterior probabilities for risk prediction.
- Analyzed serial BP measurements from 152,633 participants across two longitudinal cohort studies (BLSA and VHM&PP).
- Employed time-dependent BP indices to account for intraindividual changes over time.
Main Results:
- Pulse pressure (PP) and systolic blood pressure (SBP) showed superior predictive accuracy for CHD in women.
- Mean arterial pressure (MAP) and diastolic blood pressure (DBP) demonstrated better performance in predicting CHD for men.
- Discrimination varied by BP index and gender, with women generally showing greater but more varied discrimination.
Conclusions:
- Longitudinally collected BP measurements reveal significant gender-specific differences in predicting CHD.
- Gender-specific BP indices are crucial for accurate individual CHD risk assessment.
Background:
Previous studies on blood pressure (BP) indices as a predictor of coronary heart disease (CHD) have provided equivocal results and generally relied on Cox proportional hazards regression methodology, with age and sex accounting for most of the predictive capability of the model.
Objective:
The aim of the present study was to use serially collected BP measurements to examine age-and gender-related differences in BP indices for predicting CHD.
Methods:
The predictive accuracy of time-dependent BP indices for CHD was investigated using a method of risk prediction based on posterior probabilities calculated from mixed-effects regression to utilize intraindividual differences in serial BP measurements according to age changes within gender groups. Data were collected prospectively from 2 community-dwelling cohort studies in the United States (Baltimore Longitudinal Study of Aging [BLSA]) and Europe (Vorarlberg Health Monitoring and Promotion Program [VHM&PP]).
Results:
The study comprised 152,633 participants (aged 30-74 years) and 610,061 BP measurements. During mean follow-up of 7.5 years, 2457 nonfatal and fatal CHD events were observed. In both study populations, pulse pressure (PP) and systolic blood pressure (SBP) performed best as individual predictors of CHD in women (area under the receiver operating characteristic curve [AUC(ROC)] was between 0.83 and 0.85 for PP, and between 0.77 and 0.81 for SBP). Mean arterial pressure (MAP) and diastolic blood pressure (DBP) performed better for men (AUC(ROC) = 0.67 and 0.65 for MAP and DBP, respectively, in the BLSA; AUC(ROC) = 0.77 and 0.75 in the VHM&PP) than for women (AUC(ROC) = 0.60 for both MAP and DBP in the BLSA; AUC(ROC) = 0.75 and 0.52, respectively, in the VHM&PP). The degree of discrimination in both populations was overall greater but more varied for all BP indices for women (AUC(ROC) estimates between 0.85 [PP in the VHM&PP] and 0.52 [DBP in the VHM&PP]) than for men (AUC(ROC) estimates between 0.78 [MAP + PP in the VHM&PP] and 0.63 [PP in the BLSA]).
Conclusion:
Our findings indicate differences in discrimination between women and men in the accuracy of longitudinally collected BP measurements for predicting CHD, implicating the usefulness of gender-specific BP indices to assess individual CHD risk.
Related Concept Videos
01:28Factors affecting Blood pressure
Physiological Factors:
01:25Errors occurring during blood pressure monitoring
Several factors...
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:30Coronary Artery Disease I: Introduction
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:17Measurement of Blood Pressure