Affiliation:
1. From the Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., H.N., J.T.W., D.M.L.-J., N.B.A.)
2. Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (C.O.W., X.T.)
3. Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (M.J.D.).
Abstract
Hypertension is a major risk factor for cardiovascular disease (CVD), but previous studies have mostly been limited to a single exam, a single cohort, a short follow-up period, or a limited number of outcomes. This study aimed to assess the association of 10-year cumulative systolic blood pressure (BP) in middle age with long-term risk of any CVD, coronary heart disease, stroke, heart failure, all-cause mortality, and healthy longevity. Individuals (11 502) from 5 racially/ethnically diverse US community-based cohorts were included in this study once they met all the inclusion criteria: ≥10 year of observation in the included cohort, aged 45 to 60 years, free of CVD, and had ≥3 visits with BP exams over the preceding 10 years. For each participant, systolic BP level was predicted for each year of the 10-year prior inclusion, based on the available exams (median of 4.0; spread over, 9.1 [range, 7.2–10] years). Lower 10-year cumulative systolic BP was associated with 4.1 years longer survival and 5.4 years later onset of CVD, resulting in living longer life with a shorter period with morbidity. Models adjusted for sociodemographic characteristics, cardiovascular risk factors, and index systolic BP demonstrated associations of 10-year cumulative systolic BP (per 130 mm Hg×year change, the threshold for stage-1 hypertension) with CVD (hazard ratio [HR], 1.28 [95% CI, 1.20–1.36]), coronary heart disease (HR, 1.29 [95% CI, 1.19–1.40]), stroke (HR, 1.33 [95% CI, 1.20–1.47]), heart failure (HR, 1.12 [95% CI, 1.02–1.23]), and all-cause mortality (HR, 1.21 [95% CI, 1.14–1.29]). These findings emphasize the importance of 10-year cumulative systolic BP as a risk factor to CVD, above and beyond current systolic BP.
Publisher
Ovid Technologies (Wolters Kluwer Health)