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Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population
Fang-Fei You1, Wen-Fang Zhong1, Yi-Ning Gao1
1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.
Insights
Long-term cumulative blood pressure (cBP) significantly increases cardiovascular disease risk in Chinese adults over 45, particularly those under 60. Cumulative blood pressure load offers better prediction than single measurements for cardiovascular outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a leading global health issue.
- Limited research exists on long-term cumulative blood pressure (cBP) exposure in China's middle-aged and older population.
- Understanding cBP's impact is crucial for CVD prevention strategies.
Purpose of the Study:
- To investigate the association between long-term cBP and subsequent cardiovascular outcomes.
- To analyze these associations in Chinese individuals over 45 without pre-existing CVD.
- To compare the predictive value of cBP load versus single BP measurements.
Main Methods:
- Utilized data from 6435 participants in the China Health and Retirement Longitudinal Study (CHARLS).
- Calculated cumulative blood pressure (cBP) using area under the curve from 2011 to 2013.
- Assessed outcomes including CVD, heart disease, and stroke over a median 5-year follow-up.
Main Results:
- Increased risk of CVD, heart disease, and stroke associated with higher cumulative systolic (cSBP), diastolic (cDBP), and mean arterial pressure (cMAP).
- These associations were significant for CVD only in participants younger than 60.
- Cumulative pulse pressure (cPP) showed a significant association with stroke risk across all ages; cBP load outperformed baseline BP in prediction.
Conclusions:
- Long-term cSBP, cDBP, and cMAP are linked to future CVD, particularly in those under 60.
- Cumulative pulse pressure is associated with stroke risk in the overall cohort.
- Cumulative BP assessment offers superior cardiovascular risk prediction compared to single measurements, highlighting the need for long-term BP management.
Background:
Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old.
Methods:
6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke.
Results:
During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05-1.20, HR, 1.14; 95%, 1.07-1.22, HR, 1.14; 95%, 1.07-1.22), heart disease (HR, 1.05; 95%, 0.97-1.13, HR, 1.09; 95%, 1.01-1.17, HR, 1.08; 95%, 1.00-1.16) and stroke (HR, 1.35; 95%, 1.21-1.51, HR, 1.31; 95%, 1.17-1.46, HR, 1.36; 95%, 1.22-1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10-1.38). None nonlinear relationships were identified (p-nonlinear > .05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p < .001).
Conclusions:
Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age, whereas cPP was associated with stroke only across all ages. Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement. Efforts are required to control long-term BP in assessing cardiovascular risks.
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