Association of Cumulative Systolic Blood Pressure With Long-Term Risk of Cardiovascular Disease and Healthy Longevity

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.

Cumulative exposure to elevated blood pressure better predicts cardiovascular disease risk in rural Chinese adults

“…Additionally, in the sub-group analysis stratified by age, cumulative BP remained associated with CVD incidence even after adjustment for baseline BP. This finding is highly consistent with those in the age sub-groups in the Lifetime Risk Pooling Project ( 21 ).…”

“…Previous studies have emphasized the importance of long-term exposure to elevated BP in the development of CVD. A previous study from the Lifetime Risk Pooling Project found that 10-year cumulative systolic BP exposure was a risk factor that surpassed current systolic BP for CVD and all-cause death during a median follow-up period of 12.9 years ( 21 ). The Coronary Artery Risk Development in Young Adults study discovered that quantified cumulative exposure to BP over 16 years of follow-up was associated with subsequent risks of heart failure, coronary heart disease, stroke, and CVD ( 12 ).…”

Home Blood Pressure in Target Range as an Additional Therapeutic Goal in Hypertensive Patients. Telemonitoring-based Analysis.

“…But the authors of the latter study reasonably stated that BP variability is not simply calculated at hand, and it is unclear if certain measures should be preferred over another (standard deviation, coe cient of variation, variation independent of mean, etc.). These necessitated the search for other and easy to use measures of BP uctuations, such as BP load [23], cumulative BP [24] and nally, TTR.…”

Home blood pressure in target range as an additional therapeutic goal in hypertensive patients: a telemonitoring-based analysis

“…However, the authors of the latter study reasonably stated that BP variability is not simply calculated at hand, and it is unclear whether certain measures should be preferred over others (standard deviation, coefficient of variation, variation independent of mean, etc.). This necessitated the search for other easy-to-use measures of BP fluctuations, such as BP load [23] , cumulative BP [24] , and TTR.…”