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Prediction of cardiovascular events from systolic or diastolic blood pressure
Atefeh Talebi1, Rikke Nørmark Mortensen2, Thomas Alexander Gerds3
1Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Systolic blood pressure (SBP) does not significantly improve cardiovascular risk prediction beyond diastolic blood pressure (DBP) in population studies. This finding applies to both office and 24-hour ambulatory measurements, suggesting current prediction models may not benefit from adding SBP.
Area of Science:
- Cardiovascular epidemiology
- Hypertension research
- Clinical risk prediction
Background:
- Historically, focus shifted from diastolic to systolic blood pressure (SBP) in cardiovascular risk assessment.
- Limited formal analyses exist comparing the independent prognostic value of SBP versus diastolic blood pressure (DBP).
- Understanding the incremental value of SBP is crucial for refining cardiovascular event prediction models.
Purpose of the Study:
- To determine if office SBP provides additional prognostic information beyond office DBP.
- To assess the specific importance of both 24-hour ambulatory SBP and DBP for cardiovascular risk prediction.
- To evaluate the discriminative and calibration abilities of blood pressure measurements in predicting cardiovascular outcomes.
Main Methods:
- Analysis of 2097 participants from a Copenhagen population cohort.
- Cause-specific Cox regression models to predict 10-year risks of fatal and non-fatal cardiovascular (CV) events.
- Time-dependent area under the receiver operator curve (AUC), calibration plots (Hosmer-May test), and Brier scores were used to evaluate model performance.
Main Results:
- Adding 24-hour ambulatory SBP and DBP did not significantly increase AUC for CV mortality or CV events.
- Adding office SBP and DBP did not significantly improve AUC for CV mortality or CV events.
- Office SBP did not improve prognostic information beyond office DBP for CV mortality and CV events.
Conclusions:
- For the general population, adding systolic blood pressure to diastolic blood pressure does not improve 10-year discriminative ability for predicting cardiovascular death or events.
- This conclusion holds true for both office-based and 24-hour ambulatory blood pressure measurements.
- Current cardiovascular risk prediction models may not benefit from the inclusion of SBP as an independent predictor when DBP is already considered.
Abstract:
Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24-h ambulatory SBP and 24-h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause-specific Cox regression was performed to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular (CV) events. Also, the time-dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer-May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24-h ambulatory SBP and 24-h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p-value) was .26% (-.2% to .73%; .27) for 10-year CV mortality and .69% (-.09% to 1.46%; .082) for 10-year risk of CV events. The difference in AUC was .12% (-.2% to .44%; .46) for 10-year CV mortality and .04% (-.35 to .42%; .85) for 10-year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were .078 and .077, respectively. Furthermore, the Brier scores were .077 and .078 in CV mortality and CV events of 24-h ambulatory. For the average population as those participating in a population survey, the 10-year discriminative ability for long-term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.
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