Blood pressure trajectories in relation to cardiovascular mortality: The Rancho Bernardo Study

Area of Science:

• Cardiology
• Epidemiology
• Gerontology

Background:

• The predictive value of blood pressure (BP) trajectories for cardiovascular disease (CVD) risk is not well understood.
• Previous studies have primarily focused on average BP levels, neglecting the dynamic changes over time.

Purpose of the Study:

• To investigate the association of systolic blood pressure (SBP) trajectories with CVD and all-cause mortality.
• To compare the predictive value of SBP trajectories against average SBP, considering antihypertensive medication use.

Main Methods:

• Utilized data from 762 participants in the Rancho Bernardo Study (1984-2013).
• Derived SBP trajectories using group-based trajectory modeling from five examinations.
• Employed Cox proportional hazards analysis, adjusting for relevant covariates.

Main Results:

• Identified four distinct SBP trajectories, with some showing a 5-12 mmHg increase over 10 years.
• Higher SBP trajectories were linked to 2-3 times greater CVD mortality and 1.5 times greater all-cause mortality risk.
• SBP trajectories offered no superior predictive value for CVD or all-cause mortality compared to average SBP.

Conclusions:

• In middle-aged and older adults, SBP trajectories do not provide added value beyond average SBP for predicting CVD and all-cause mortality.
• Both long-term average SBP and SBP trajectories are significant predictors of mortality.
• These associations remained consistent regardless of antihypertensive medication use.