Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures

Kim, Jung Ki; Crimmins, Eileen M.

doi:10.31546/2633-7916.1009

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…The association between lower BP and mortality is still of discussion. [53][54][55] Most studies have found this association among elderly people and linked it to chronic disease, for example, cardiovascular disease (cardiac failure or ischaemic heart disease), cancer, poor functional status or frailty. Low BP has also been associated with poor function and low quality of life, 56 57 but in previous studies only the highest quartile or the clinical cut-off value have been used as predictor of all-cause mortality.…”

Section: Open Accessmentioning

confidence: 99%

Allostatic load as predictor of mortality: a cohort study from Lolland-Falster, Denmark

et al. 2022

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ObjectivesThe purposes of the present study were to determine the association between (1) 10 individual biomarkers and all-cause mortality; and between (2) allostatic load (AL), across three physiological systems (cardiovascular, inflammatory, metabolic) and all-cause mortality.DesignProspective cohort study.SettingWe used data from the Lolland-Falster Health Study undertaken in Denmark in 2016–2020 and used data on systolic blood pressure (SBP) and diastolic blood pressure (DBP), pulse rate (PR), waist–hip ratio (WHR) and levels of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, glycated haemoglobin A1c (HbA1c), C-reactive protein (CRP) and serum albumin. All biomarkers were divided into quartiles with high-risk values defined as those in the highest (PR, WHR, triglycerides, HbA1c, CRP) or lowest (HDL-c, albumin) quartile, or a combination hereof (LDL-c, SBP, DBP). The 10 biomarkers were combined into a summary measure of AL index. Participants were followed-up for death for an average of 2.6 years.ParticipantsWe examined a total of 13 725 individuals aged 18+ years.Primary outcome measureCox proportional hazard regression (HR) analysis were performed to examine the association between AL index and mortality in men and women.ResultsAll-cause mortality increased with increasing AL index. With low AL index as reference, the HR was 1.33 (95% CI: 0.89 to 1.98) for mid AL, and HR 2.37 (95% CI: 1.58 to 3.54) for high AL.ConclusionsElevated physiological burden measured by mid and high AL index was associated with a steeper increase of mortality than individual biomarkers.

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Section: Open Accessmentioning

confidence: 99%

Allostatic load as predictor of mortality: a cohort study from Lolland-Falster, Denmark

et al. 2022

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“…Our findings support an emerging literature that documents an independent association between ePWV and the risk of all-cause mortality ( Heffernan et al, 2020a , 2020b ; Vlachopoulos et al, 2019 ). In the current study, ePWV remained significantly associated with mortality in our fully specified model, which included such predictors of mortality as socioeconomic status (i.e., wealth, income, and education; Feinglass et al, 2007 ), physical activity ( Wen et al, 2014 ), CRP ( Li, Zhong et al, 2019 ), glycated hemoglobin ( Li, Zhang et al, 2019 ), and blood pressure ( Kim & Crimmins, 2020 ). As a reflection of vascular aging, loss of arterial elasticity (i.e., increasing arterial stiffness) exposes target organs to increases in pulsatile hemodynamic forces ( Chirinos et al, 2019 ).…”

Section: Discussionmentioning

confidence: 79%

“…Specifically, when entering ePWV into our second model that includes its constituent elements, the coefficient on systolic blood pressure changes from positive to negative and is statistically significant, while chronological age is no longer significantly associated with mortality. In the HRS, it has been shown that low systolic and diastolic blood pressure is associated with a higher risk of mortality among older adults with a history of CVD (and likely accelerated vascular aging), and that those with low systolic blood pressure have the poorest survival ( Kim & Crimmins, 2020 ). The joint effects of blood pressure and vascular aging on mortality warrant additional study.…”

Section: Discussionmentioning

confidence: 99%

Estimated Pulse Wave Velocity and All-Cause Mortality: Findings From the Health and Retirement Study

Heffernan

Wilmoth

London

2022

Innovation in Aging

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Background and Objectives The gold standard method for the assessment of vascular aging is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated from two commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle-age and older adults. Research Design and Methods Cox proportional hazard models were used to predict mortality occurring over a 10 to12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease, diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and cardiovascular disease (CVD)-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). Results By 2018, 26.19% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality. Discussion and Implications An estimate of PWV derived from age and blood pressure is independently associated with increased likelihood of death in a representative sample of middle-age and older adults in the U.S.

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“…Our CMR score included PP as well as SBP and DBP, while the CMR score in the study of Mitchell et al only included PP. While PP is a good indicator of arterial stiffness, we believe that using PP alone to reflect blood pressure in a summary CMR is not sufficient ( 29–32 ). Recent literature has suggested treating high PP as an additional risk under the condition of high SBP ( 22 , 33–35 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiometabolic Risk Trajectory Among Older Americans: Findings From the Health and Retirement Study

Ailshire

Kim

et al. 2021

The Journals of Gerontology: Series A

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Background Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined. Methods We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use. Results Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication. Conclusions The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

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Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures

Cited by 11 publications

References 21 publications

Allostatic load as predictor of mortality: a cohort study from Lolland-Falster, Denmark

Allostatic load as predictor of mortality: a cohort study from Lolland-Falster, Denmark

Estimated Pulse Wave Velocity and All-Cause Mortality: Findings From the Health and Retirement Study

Cardiometabolic Risk Trajectory Among Older Americans: Findings From the Health and Retirement Study

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