Association Between Blood Pressure Level and the Risk of Myocardial Infarction, Stroke, and Total Mortality

Psaty, Bruce M.; Furberg, Curt D.; Kuller, Lewis H.; Cushman, Mary; Savage, Peter J.; Levine, David M.; O’Leary, Daniel H.; Bryan, R. Nick; Anderson, Melissa L.; Lumley, Thomas

doi:10.1001/archinte.161.9.1183

Cited by 380 publications

(274 citation statements)

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“…Ten treatable risk factors have been associated with 90% of the risk of ischemic or hemorrhagic stroke (O'Donnell et al., 2010). The risk profile for occurrence of MI is quite different than that for stroke (Yusuf et al., 2004), but hypertension is one important risk factor for stroke, MI or vascular cause of death (Carlson & Böttiger, 1985; Conroy et al., 2003; Håheim et al., 1993; Harmsen et al., 1990; Hu et al., 2005; Psaty et al., 2001; Qizilbash, Lewington, Duffy, & Peto, 1995; Seshadri et al., 2006) and antihypertensive treatment(s) reduces these risks (Hackam & Spence, 2007; Hankey, 2014; Mancia et al., 2013; Turnbull, 2003; Turnbull et al., 2005; Wachtell, Hornestam, et al., 2005; Wachtell, Lehto, et al., 2005). …”

Section: Discussionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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ObjectivesTo assess long‐term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given.Materials and MethodsRetro/prospective follow‐up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011.ResultsA total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first‐line treatment had beneficial effects on survival: AC OR 0.67 (0.5–0.9), APT 0.67 (0.52–0.88) versus untreated.ConclusionsPatients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.

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Section: Discussionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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“…8,9 In the elderly, some disagreement has surrounded the importance of monitoring and treating SBP, DBP, or both, as well as whether to treat isolated and/or borderline isolated systolic hypertension. 7,[10][11][12][13] Further, in the very elderly, older than 80 years, BP elevations have shown an association with better survival. [14][15][16] Despite these areas of controversy, treatment is commonly recommended for identified hypertension in the elderly and in middle-aged adults, as participants with stage 1 or 2 hypertension have shown that lowering systolic pressure by 10-12 mm Hg and diastolic pressure by 5-6 mm Hg reduces CVD event rates.…”

Section: Introductionmentioning

confidence: 96%

Blood pressure as a predictor of cardiovascular events in the elderly: the William Hale Research Program

2006

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This study evaluates the association between blood pressure (BP) and the risk of developing cardiovascular disease (CVD) events in the elderly. The Morton Plant Mease Foundation has followed 4008 elderly patients 464 years of age for at least 5 years. Systolic and diastolic blood pressure (SBP and DBP) was divided into categories. Cardiovascular disease events were classified as myocardial infarction, stroke, and CVDrelated deaths reported from the National Death Index. Cox proportional hazard ratios were used to assess the relationship between BP and CVD events and controlled for weight, gender, smoker, and alcohol use. Ages o75 and X75 years were assessed separately. After 11.1 years of follow-up, elevated SBP (P ¼ o0.0001) is strongly associated with developing a future CVD event; the relationship is linear and graded and holds for ages above and below 75 years. The frequency of CVD events was lowest in the SBP o120 mm Hg group. In subjects o75 years of age, DBP elevations were not a significant risk factor for CVD events. (relative risk (RR): DBP 70 to o80 mm Hg ¼ 0.92; DBP 80 to o90 mm Hg ¼ 0.88; DBP X90 mm Hg ¼ 1.02.) With subjects X75 years of age, a DBP between 80 and 90 is associated with the lowest significant risk for CVD (RR: DBP 70 to o80 mm Hg ¼ 0.74; DBP 80 to o90 mm Hg ¼ 0.59; DBP X90 ¼ 0.71). In conclusion, these findings support the Joint National Committee on Hypertension recommendations for SBP in the elderly. Further studies are warranted to identify optimal DBP for the elderly at various ages.

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“…21 In the women of Finnmark Study, DBP was associated with incident diabetes in the age-adjusted model but not in the multivariable-adjusted model. 22 Although many studies examined PP and MAP as predictors of CVD, 23,24 there is lack of data regarding the effect of these components for prediction of diabetes, compared with other BP components. Kramer et al 21 in the Rancho Bernardo study showed that 10 mm Hg increases in PP causes a 20% increase in risk of diabetes in the multivariable-adjusted model.…”

Section: Discussionmentioning

confidence: 99%

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study

et al. 2011

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Elevated blood pressure (BP) may lead to incident diabetes. However, data about the effect of different BP components on incident diabetes in Middle Eastern women is lacking. We evaluated systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP) as independent predictors of diabetes in Iranian women. We performed a populationbased prospective study among 3028 non-diabetic women, aged X20 years. Odds ratios (ORs) of diabetes were calculated for every 1 s.d. increase in SBP, DBP, PP and MAP. During E6 years of follow-up, 220 women developed diabetes. There were significant interactions between family history of diabetes and SBP, PP and MAP (Pp0.01) in predicting incident diabetes. In women without a family history of diabetes, all BP components were significantly associated with diabetes in the ageadjusted model; the risk factor-adjusted ORs were significant (Po0.05) for SBP, PP and MAP (1.30, 1.34 and 1.27, respectively) with similar predictive ability (area under the receiver operating characteristic curve E83%). In women with family history of diabetes, in the age-adjusted model, SBP, DBP and MAP were associated with diabetes; in multivariable model, they were not independent predictors of diabetes. In conclusion, in women without family history of diabetes, SBP, PP and MAP, were independent predictors of diabetes with almost similar predictive ability; hence, in the evaluation of the risk of BP components for prediction of diabetes, the presence of family history of diabetes should be considered.

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Association Between Blood Pressure Level and the Risk of Myocardial Infarction, Stroke, and Total Mortality

Abstract: In this population-based study of older adults, although all measures of blood pressure were strongly and directly related to the risk of coronary and cerebrovascular events, SBP was the best single predictor of cardiovascular events.

Cited by 380 publications

References 34 publications

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Blood pressure as a predictor of cardiovascular events in the elderly: the William Hale Research Program

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study

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