Blood pressure trajectories in relation to cardiovascular mortality: The Rancho Bernardo Study

Abstract

The added value of blood pressure (BP) trajectories for predicting cardiovascular disease (CVD) is currently unknown. We investigated the association of systolic BP (SBP) trajectories with CVD and all-cause mortality and compared these associations with those of average SBP, taking antihypertensive medication into account. Data from 762 participants of the Rancho Bernardo Study were used. SBP from five examinations (maximum) from 1984 to 2002 was used; mortality data were obtained from 2002 to 2013. SBP trajectories were derived using group-based trajectory modelling. Cox proportional hazards analysis was used to investigate associations of trajectories and average SBP with CVD and all-cause mortality, adjusted for age, sex, cholesterol, smoking, diabetes and antihypertensive medication. Mean baseline age was 65.7 years, and 67% were women. Four trajectories were identified, in which mean SBP increased by 5-12 mm Hg during 10 years. The highest trajectories were associated with two to three times greater CVD mortality and 1.5 times greater all-cause mortality risk, compared with the lowest trajectory. Each 20 mmHg increment in average SBP was associated with 1.4 times greater CVD mortality risk and 1.2 times all-cause mortality risk. Associations were not modified by antihypertensive medication (P-interaction>0.10). SBP trajectories were not superior to average SBP in predicting CVD and all-cause mortality. In the general middle-aged and older population of the Rancho Bernardo study, SBP trajectories provided no added value to average SBP in predicting CVD and all-cause mortality. Long-term average SBP levels and trajectories were significant predictors of CVD and all-cause mortality, irrespective of prescribed antihypertensive medication (which in the 1980s-1990s mainly were diuretics and β-blockers).

Longitudinal blood pressure patterns and cardiovascular disease risk

“…However, BP trajectories may have additional value for predicting CVD compared to approaches such as the time-averaged BP, because trajectories capture both the level and longitudinal changes of BP. To this date, three studies have addressed the relationship between long-term BP trajectories and subsequent CVD mortality (Table 2) [26,44,45]. First, Tielemans et al studied two cohorts of men aged 50 years originating from the Minnesota Business and Professional Men Study and the Zutphen Study [44].…”

“…In a third publication, the association between four SBP trajectories and subsequent CVD mortality were investigated in the Rancho Bernardo Study (Table 2) [45]. Over 15 years of follow-up, a maximum of five BP measurements were obtained from 762 participants (mean age 65.7 years at baseline, 67% women) who were followed up for 12 years for CVD outcomes.…”

Evolution of Cardiovascular Risk Factors in a Worker Cohort: A Cluster Analysis

“…Several studies have analyzed the trajectories of one [ 18 , 19 , 20 , 21 ] or several [ 22 , 23 ] CVRFs using a variety of different methods, and have attempted to identify correlations between their findings and other factors or diseases. One such study [ 19 ] analyzed the evolution of SBP, for which 4 distinct trajectories were identified over time. The authors found that SBP trajectories predicted CVD and all-cause mortality no better than did mean SBP values.…”

Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review

“…The association between longitudinal measurements of blood pressure and risk of CVD has been studied using summaries such as time-averaged, cumulative, [ 8 ] trajectory patterns [ 9 ] and variability [ 10 , 11 ]. However, less effort has been invested in modelling the complete record of longitudinal measurements, e.g.…”