Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes

Flint, Alexander C.; Conell, Carol; Ren, Xiushui; Banki, Nader M.; Chan, Sheila L.; Rao, V.; Melles, Ronald B.; Bhatt, Deepak L.

doi:10.1056/nejmoa1803180

Cited by 443 publications

(360 citation statements)

References 22 publications

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“…Hypertension (HTN), one of the most well-known chronic diseases, has a multifactorial nature linked to the possible interaction of genetic and environmental risk factors [1,2]. Furthermore, HTN is a very important modifiable risk factor for cardiovascular morbidity and mortality [3,4]. Identifying and controlling various risk factors for HTN is critical to prevent its irreversible consequences and to guide treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

Interactive effect of high sodium intake with increased serum triglycerides on hypertension

2020

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Background A high salt diet is associated with the development of hypertension, one of the most important cardiovascular risk factors. A reduction in sodium intake seems to have an effect on increasing serum triglycerides (TGs). Elevated TGs are independently linked to cardiovascular risk. However, there is limited evidence of a possible interactive effect of sodium intake and serum TGs on high blood pressure (BP). Methods We conducted a nationwide, population-based interaction analysis using the Kawasaki method for estimating 24-h urinary sodium excretion (e24hUNaE Kawasaki) as a candidate indicator of dietary sodium intake. All native Koreans aged 20 years or older without significant medical illness were eligible for inclusion. Results A total of 16936 participants were divided into quintiles according to their e24hUNaE Kawasaki results. Participants in the highest quintile were more obese and hypertensive and had higher white blood cell count, lower hemoglobin, greater glycemic exposure, and poor lipid profiles compared to the same parameters of individuals in other quintiles. Linear regression revealed that e24UNaE Kawasaki was related to systolic BP, diastolic BP, and TGs. Multiple logistic regression, adjusted for dietary sodium intake and various conventional risk factors for chronic vascular diseases, showed that both e24UNaE Kawasaki and TGs were significant predictors of hypertension. Our interaction analysis demonstrated that increased sodium intake was associated with higher risk of hypertension in participants with elevated TGs than in those without (adjusted RERI = 0.022, 95% CI = 0.

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Section: Introductionmentioning

confidence: 99%

Interactive effect of high sodium intake with increased serum triglycerides on hypertension

2020

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“…High blood pressure (BP) is a well-studied and established risk factor for cardiovascular disease (CVD) [1][2][3] and is commonly observed in the emergency department (ED). 4 Hypertension accounts for nearly fifty per cent of the mortality in stroke and heart disease, and every year approximately 9.4 million cardiovascular deaths occur due to complications of hypertension, which makes hypertension the most important risk factor for disability and death worldwide.…”

Section: Introductionmentioning

confidence: 99%

Elevated blood pressure in the emergency department – a risk factor for incident cardiovascular disease: An EHR-based cohort study

Oras

Häbel

Skoglund

et al. 2019

Preprint

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Objectives: In the emergency department (ED), high blood pressure (BP) is commonly observed but mostly used to evaluate patients' health in the short-term. We aimed to study whether ED-measured BP is associated with incident atherosclerotic cardiovascular disease (ASCVD), myocardial infarction (MI), or stroke in long-term, and to estimate the number needed to screen (NNS) to prevent ASCVD. Design: Electronic Health Records (EHR) and national register-based cohort study. The association between BP and incident ASCVD was studied with Cox-regression. Setting: Two university hospital emergency departments in Sweden. Data sources: BP data were obtained from EDs EHR, and outcome information was acquired through the Swedish National Patient Register for all participants. Participants: All patients ≥18 years old who visited the EDs between 2010 to 2016, with an obtained BP (n=300,193). Main outcome measures: Incident ASCVD, MI, and stroke during follow-up. Results: The subjects were followed for a median of 42 months. 8,999 incident ASCVD events occurred (MI: 4,847, stroke: 6,661). Both diastolic and systolic BP (SBP) was associated with incident ASCVD, MI, and stroke with a progressively increased risk for SBP within hypertension grade 1 (HR 1.15, 95% CI 1.06 to 1.24), 2 (HR 1.35, 95% CI 1.25 to 1.47), and 3 (HR 1.63, 95% CI 1.49 to 1.77). The six-year cumulative incidence of ASCVD was 12% for patients with SBP ≥180 mmHg compared to 2% for normal levels. To prevent one ASCVD event during the median follow-up, NNS was estimated to 151, whereas NNT to 71. Conclusions: BP in the ED is associated with incident ASCVD, MI, and stroke. High BP recordings in EDs should not be disregarded as isolated events, but an opportunity to detect and improve treatment of hypertension. ED-measured BP provides an important and under-used tool with great potential to reduce morbidity and mortality associated with hypertension.

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“…A recent study of multiple cohorts of US adults reported that IDH was not linked to an increased risk of CVD by either hypertension definition (≥140/90 mm Hg or ≥ 130/80 mm Hg). In contrast, a study of the US outpatient population reported that both systolic and diastolic hypertension independently predicted CVD events [8], regardless of the definition of hypertension.…”

Section: Introductionmentioning

confidence: 87%

Hypertension Subtype Defined by the 2017 ACC/AHA Blood Pressure Guidelines and Risk of Cardiovascular Disease: A Large Prospective Cohort Study

2020

Preprint

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IMPORTANCE The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guidelines lowered the hypertension threshold from a systolic blood pressure/diastolic blood pressure level of ≥140/90 mm Hg to ≥130/80 mm Hg. The cardiovascular impact of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) under the new definition remains unclear. OBJECTIVE To examine the associations of ISH and IDH defined by the 2017 ACC/AHA guidelines with risk of cardiovascular disease (CVD) among the UK population. DESIGN, SETTING, AND PARTICIPANTS We used data from the UK Biobank study, which is a prospective population-based cohort study. Participants were categorized into 5 groups: normal BP, normal high BP, ISH, IDH and systolic and diastolic hypertension (SDH). MAIN OUTCOMES AND MEASURES The primary endpoint for this study was the composite of nonfatal myocardial infarction (MI), nonfatal ischemic stroke (IS), nonfatal haemorrhagic stroke (HS) and CVD death. We also explored the results for the above mentioned CVD outcomes separately. Baseline BP measurements were obtained twice after the participant had been at rest for at least 5 minutes in a seated position. RESULTS We included 470,625 participants who were free of CVD at baseline and had available data on BP measures. During a median follow-up of 8.1 years, 13,157 CVD events were recorded, including 6,865 nonfatal MI, 3,415 nonfatal ISs, 1,118 nonfatal HSs, and 2,971 CVD deaths. According to the hypertension threshold of ≥130/80 mm Hg by the ACC/AHA guidelines, both ISH (HR 1.35, 95% CI 1.24-1.46) and IDH (HR 1.22, 95% CI 1.11-1.36) were significantly associated with a higher overall CVD risk as compared with normal BP. ISH was associated with most CVD risk, except for IS, while the excess CVD risk associated with IDH appeared to be driven mainly by MI. We found heterogeneity by sex and age regarding the effects of IDH on overall CVD risk, with significant associations in younger adults (age < 60 years) and women and null associations in men and older adults (age ≥60 years). CONCLUSIONS AND RELEVANCE Both ISH and IDH were associated with an increased risk of CVD among the UK population according to the ACC/AHA BP guidelines. Further research is needed to identify participants with IDH who have a particularly risk for developing CVD.

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Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes

Cited by 443 publications

References 22 publications

Interactive effect of high sodium intake with increased serum triglycerides on hypertension

Interactive effect of high sodium intake with increased serum triglycerides on hypertension

Elevated blood pressure in the emergency department – a risk factor for incident cardiovascular disease: An EHR-based cohort study

Hypertension Subtype Defined by the 2017 ACC/AHA Blood Pressure Guidelines and Risk of Cardiovascular Disease: A Large Prospective Cohort Study

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