This article is more than 5 years old. Information may no longer be current.
Study identifies substantial heterogeneity in predictive value of BP
Click Here to Manage Email Alerts
Elevated systolic and diastolic BP may have varying effects on different types of CVDs and at different ages, according to a new report of 1.25 million patients from primary care practices in England.
Results from the new study indicate that patients with higher systolic BP have an elevated risk for intracerebral hemorrhage, subarachnoid hemorrhage and stable angina. Elevated diastolic BP, however, may be a better indicator of risk for abdominal aortic aneurysm.
Researchers utilized linked electronic health records from the CALIBER program between 1997 and 2010 to generate a cohort of 1.25 million patients aged 30 years or older with no CVD. One-fifth of the cohort received BP-lowering medication. The patients were followed for a median of 5.2 years to record the first CV event. The researchers also calculated lifetime risks for developing 12 acute and chronic CVDs linked to high BP at age 30 to 80 years. For this study, hypertension was defined as BP ≥140 mm Hg/90 mm Hg or need for BP-lowering medication.
During the study period, the researchers identified 83,098 initial presentations of CVD. At all index age groups, patients with systolic BP of 90 mm Hg to 114 mm Hg and diastolic BP of 60 mm Hg to 74 mm Hg had the lowest risk for CVD. The researchers observed no J-shaped associations between increased risk at lower BP levels.
“The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect,” the researchers wrote in The Lancet.
According to the results, associations with high systolic BP were weakest for abdominal aortic aneurysm (HR=1.08; 95% CI, 1-1.17) and strongest for stable angina (HR=1.41; 95% CI, 1.36-1.46), subarachnoid hemorrhage (HR=1.43; 95% CI, 1.25-1.63) and intracerebral hemorrhage (HR=1.44; 95% CI, 1.32-1.58). When compared with diastolic BP, elevated systolic BP had a greater effect on angina, MI and peripheral arterial disease. Compared with systolic BP, elevated diastolic BP had a greater effect on abdominal aortic aneurysm, according to the study results. The researchers reported an inverse association between pulse pressure and abdominal aortic aneurysm (HR per 10 mm Hg=0.91; 95% CI, 0.86-0.98) and a strong association with PAD (HR=1.23; 95% CI, 1.2-1.27).
In other results, the lifetime risk for overall CVD for patients with hypertension was 63.3% at age 30 years compared with 46.1% for patients with normal BP. These patients developed CVD an average of 5 years earlier than patients with normal BP. Much of the hypertension-related, CVD-free years lost from index age 30 years was related to stable and unstable angina (43%), whereas most of the years lost from index age 80 years was related to HF (19%) and stable angina (19%).
“For the first time, we estimate lifetime risks and years of life lost to different types of cardiovascular disease through the application of competing risks methodology,” the researchers wrote. “A better understanding of the different associations of blood pressure with different types of cardiovascular disease and the lifetime risks associated with hypertension at different ages will help to focus guidelines and clinicians to the disease areas in which screening and treatments are more likely to have an effect.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts