The predictive value of cumulative blood pressure (BP) on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has hardly been studied. In this prospective cohort study including 52,385 participants from the Kailuan Group who attended three medical examinations and without CCE, the impact of cumulative systolic BP (cumSBP) and cumulative diastolic BP (cumDBP) on all-cause mortality and CCEs was investigated. For the study population, the mean (standard deviation) age was 48.82 (11.77) years of which 40,141 (76.6%) were male. The follow-up for all-cause mortality and CCEs was 3.96 (0.48) and 2.98 (0.41) years, respectively. Multivariate Cox proportional hazards regression analysis showed that for every 10 mm Hg·year increase in cumSBP and 5 mm Hg·year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029). Using natural spline function analysis, cumSBP and cumDBP showed a J-curve relationship with CCEs; and a U-curve relationship with stroke (ischemic stroke and hemorrhagic stroke). Therefore, increases in cumSBP and cumDBP were predictive for allcause mortality, CCEs, and stroke.Hypertension is the most common chronic disease, and the most important risk factor for cardiovascular disease 1 . Stroke and myocardial infarction (MI) are the main complications of hypertension that can lead to death 1-4 . The Framingham Study showed that starting from 115/75 mm Hg, the risk for cardiovascular events increases following the increase in blood pressure (BP) 5 . It takes time for exposure to high BP to become a risk of all-cause mortality and cardiovascular and cerebrovascular events (CCEs); and there are many factors affecting BP, such as age, diet, lifestyle, and use of antihypertensive drugs. Therefore, using a single BP measurement to predict all-cause mortality and the occurrence of CCE is not reliable.Cumulative exposure is calculated as the product of the dose level and the exposure time and has been used to predict the impact of exposures on the target organ. Since Doll and Hill first proposed that high cumulative exposure to smoking is associated with lung cancer 6,7 , it has been suggested that cumulative exposure to high blood sugar level increases the risk of complications of diabetes 8 , cumulative exposure to high cholesterol level increases the risk for coronary heart disease 9 , and cumulative exposure to high BP is associated with kidney damage 10 . However, there is hardly any study on the predictive value of cumulative exposure to elevated BP on all-cause mortality and the occurrence of CCEs. In this study, we used data collected from the Kailuan Study (Trial identification: ChiCTR-TNC-11001489; Trial registration site: http://www.chictr.org.cn/index.aspx; Registration number: 11001489) and analyzed the predictive value of cumulative BP for all-cause mortal...
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