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Systolic BP better indicator than diastolic BP of future CVD in young black patients
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In a study recently published in JAMA Cardiology, researchers presented data countering the common view that diastolic BP better identifies future CVD events than systolic BP in people aged 50 years and younger.
They found that, in young black individuals, systolic BP was more able to predict future CVD, whereas in young white individuals, diastolic BP was more able to predict future CVD. Additionally, when participants were middle-aged, systolic BP better identified risk of incident CVD in both races.
Yuichiro Yano, MD, PhD, from the department of preventive medicine at Northwestern University Feinberg School of Medicine, and colleagues used data from the CARDIA study, which evaluated the longitudinal race-stratified links between BP and CV outcomes with 28 years of follow-up.
Participants from the study (n = 4,880), recruited from March 26, 1985, to June 7, 1986, were black or white, ranging in age from 18 to 30 years. From August 2009 to August 2014, 94% of the cohort who were still alive finished at least one telephone interview.
At the baseline measurement of BP, the mean BP measurement was 112 mm Hg systolic/69 mm Hg diastolic in black participants; it was 109 mm Hg systolic/68 mm Hg diastolic in white participants. Fifteen years after baseline, the mean BP measurement was 117 mm Hg systolic/77 mm Hg diastolic in black individuals; it was 110 mm Hg systolic/72 mm Hg diastolic in white individuals.
The researchers adjusted for covariates and used Cox proportional hazards models.
At baseline, systolic BP (HR per 1-standard deviation increase = 1.32; 95% CI, 1.09-1.61) but not diastolic BP (HR = 1.05; 95% CI, 0.88-1.26) was found to be linked to CVD risk in black individuals. However, in white individuals, diastolic BP (HR = 1.74; 95% CI, 1.21-2.5) but not systolic BP (HR = 0.82; 95% CI, 0.57-1.18) was found to be associated with increased CVD risk.
Furthermore, at 15 years after baseline, systolic BP was the stronger indicator over diastolic BP of risk for CVD in black participants (HR = 1.64; 95% CI, 1.25-2.16), as well as in white participants (HR = 1.67; 95% CI, 1.02-2.69).
“Yano and colleagues use data from the [CARDIA] study to demonstrate that the prognostic information conferred by [systolic] BP and [diastolic] BP may vary considerably by both race and age. These differences have important implications for the performance of risk models to identify high-risk adults for CVD prevention. Unfortunately, most clinical trials and epidemiologic studies of hypertension have included mostly older white populations. As such, racial differences in the link between BP and CVD risk will lead to risk models and treatment paradigms that underperform in minority populations,” Ann Marie Navar, MD, PhD, and Eric Peterson, MD, MPH, of Duke Clinical Research Institute, wrote in a related editorial.
“Over the past 100 years, we have learned much about hypertension and its treatment. Studies, such as the current report by Yano and colleagues, demonstrate we have much left to discover. Several things are clear. First, hypertension is not likely to be one disease. Second, the risk for elevated [systolic] BP and [diastolic] BP appear to be altered by race and age. Third, even low levels of elevated BP appear associated with future harm. As we move forward, the future of personalized medicine will require a deeper understanding of the physiology behind hypertension, with the ultimate goal of individualized prognostic and treatment approaches,” Navar and Peterson wrote. – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures. Navar reports receiving research support to her institution from Amgen, Regeneron Pharmaceuticals and Sanofi, as well as consultant fees from Sanofi. Peterson reports receiving consultant fees from AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Merck, Regeneron, Sanofi and Valeant, and research support from Janssen.
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