Cumulative mean arterial pressure and risks of adverse cardiac and cerebrovascular events: a prospective cohort study of 53,813 adults

Abstract

The association between cumulative mean arterial blood pressure (MAP) and risks of adverse cardiac and cerebrovascular events (CCVEs) has not been characterized. This prospective cohort study included 53,813 participants, free of prior myocardial infarction or stroke in or before 2010 (baseline) from a community-based cohort including 101,510 participants. Cumulative MAP was defined as the summed average MAP for each pair of consecutive examinations multiplied by the time interval with the data from previous surveys (2006- 2007, 2008 to 2009, 2010-2011). Incident adverse CCVEs were ascertained by both the information collection in biennial follow-up surveys (2012-2013, 2014-2015) and surveying each year's discharge lists from local hospitals and death certificates from state vital statistics offices by three experienced physicians blinded to the study design. The study population were stratified into quartiles based on cumulative MAP (<354.62 mmHg, n = 13,454; 354.62 to 392.82 mmHg, n = 13,452; 392.82 to 438.04 mmHg, n = 13 453; ≥ 438.04 mmHg, n = 13,454). We documented 1055 incident adverse CCVEs, including 271 myocardial infarction and 794 stroke (10 comorbid with myocardial infarction), which consisted of 673 ischemic stroke and 134 hemorrhagic stroke (13 comorbid with ischemic stroke). The incidence of adverse CCVEs increased with the increase of cumulative MAP with significant difference (p < 0.001). Cox proportional hazards regression models revealed the elevated cumulative MAP as an independent risk factor for adverse CCVEs, especially hemorrhagic stroke, after adjusting potential confounders. A J-shaped relationship between cumulative MAP and hemorrhagic stroke was also observed.

The Role of Cumulative Mean Arterial Pressure Levels in First Stroke Events Among Adults with Hypertension: A 10-Year Prospective Cohort Study

“…Third, this study adjusted for comprehensive confounding factors (including demographic characteristics, clinical measurement indicators, lifestyle variables and related disease history) and used the sensitivity analysis to further eliminate some potential effects on study results. Fourth, our large and long-term study made up for the shortcomings of previous studies on cumulative MAP cohort, and based on Cui et al ‘s study, 10 we directly targeted the population of hypertensive patients to further study the role of cumulative MAP, and expanded the specific characteristics of high-risk group.…”

“…Cumulative MAP was defined as the sum of MAP from each consecutive examination multiplied by the time interval between the two successive examinations. 10 Participants’ BP was measured monthly between June 2010 and May 2011 to observe long-term fluctuations in BP levels, and cumulative MAP was calculated using these one-year BP record data. Cumulative BP exposure model was calculated as follows: cumulative MAP = [(MAP 1 +MAP 2 )/2 × time 1-2 ] + [(MAP 2 +MAP 3 )/2 × time 2-3 ] + … + [(MAP 11 + MAP 12 )/2 × time 11-12 ].…”

“…However, few studies to date have evaluated the predictive power of cumulative MAP. 10 Therefore, the purpose of this study was to prospectively evaluate the effect of cumulative MAP on stroke events using the big data of the Follow-up Cohort Study of Hypertension (FCSH) in Jiangsu Province, China, from 2010 to 2020.…”

Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events

“…More recently, the cumulative BP determination was developed, which includes several BP measurements that take into consideration of both how high the BP levels have been and the duration of the high BP exposure before risk estimation. Several studies have simultaneously used the cumulative BP and baseline BP determinations to assess the effect of high BP on CVE occurrence, which showed that the association of the cumulative BP determination with CVE was stronger than the baseline BP determination (12)(13)(14)(15). Although cumulative BP seems to be superior than baseline BP in estimating CVE risk of high BP theoretically, no population studies have yet to verify this presumption.…”

The heart in hypertension

“…HT on its own can also lead to endothelial dysfunction due to the increased shear force exerted on the vessel wall that the endothelium is exposed to. This can promote the formation of atheroma and indeed HT is a major risk factor for myocardial infarctions and cerebrovascular accidents [25]. Studies have shown that even modest increases in BP (stage 1 HT) are associated with an increased risk of cardiovascular events [26].…”