Ten‐Year Blood Pressure Trajectories, Cardiovascular Mortality, and Life Years Lost in 2 Extinction Cohorts: the Minnesota Business and Professional Men Study and the Zutphen Study

Abstract

BackgroundBlood pressure (BP) trajectories derived from measurements repeated over years have low measurement error and may improve cardiovascular disease prediction compared to single, average, and usual BP (single BP adjusted for regression dilution). We characterized 10‐year BP trajectories and examined their association with cardiovascular mortality, all‐cause mortality, and life years lost.Methods and ResultsData from 2 prospective and nearly extinct cohorts of middle‐aged men—the Minnesota Business and Professional Men Study (n=261) and the Zutphen Study (n=632)—were used. BP was measured annually during 1947–1957 in Minnesota and 1960–1970 in Zutphen. BP trajectories were identified by latent mixture modeling. Cox proportional hazards and linear regression models examined BP trajectories with cardiovascular mortality, all‐cause mortality, and life years lost. Associations were adjusted for age, serum cholesterol, smoking, and diabetes mellitus. Mean initial age was about 50 years in both cohorts. After 10 years of BP measurements, men were followed until death on average 20 years later. All Minnesota men and 98% of Zutphen men died. Four BP trajectories were identified, in which mean systolic BP increased by 5 to 49 mm Hg in Minnesota and 5 to 20 mm Hg in Zutphen between age 50 and 60. The third systolic BP trajectories were associated with 2 to 4 times higher cardiovascular mortality risk, 2 times higher all‐cause mortality risk, and 4 to 8 life years lost, compared to the first trajectory.ConclusionsTen‐year BP trajectories were the strongest predictors, among different BP measures, of cardiovascular mortality, all‐cause mortality, and life years lost in Minnesota. However, average BP was the strongest predictor in Zutphen.

Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke

“…Those studies identified 4 to 5 parallel trajectories in which trajectories with long-term higher blood pressure related to more cardiovascular pathology. [12][13][14] In our older population, we also observed that the class with a high midlife blood pressure had the highest risk of stroke and death compared with the class with the lowest blood pressure. However, a novel finding of our study is that the slope of increase was associated with an increasing risk of stroke and competing causes of death.…”

“…However, long-term patterns (ie, trajectories) of blood pressure may further influence stroke risk. Studies in young-and middle-aged adults showed that increases in blood pressure over long periods (10-30 years) are related to an increased risk of stroke and cardiovascular disease, [11][12][13] and that trajectories of higher blood pressure relate to a higher risk of subclinical atherosclerosis. 14 Trajectories in older people may vary even more because it is particularly in later ages that arterial stiffness increases, which is associated with increases in blood pressure and blood pressure variability.…”

Natural history of coronary heart disease and heart disease of uncertain etiology: Findings from a 50-year population study

“…In comparison with relatively few population-based investigations where the quasi-extinction of the originally enrolled cohort was observed [1][2][3][4][5][6][7][8] the natural history of lifetime incident coronary and non-coronary heart diseases was even more rarely addressed giving preference to predictive analyses [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and none were performed in Italy. Overall the literature offers scanty contributions to description of natural history in population studies, frequently limited to short follow-up periods [34], or based on highly selected groups of patients [35].…”

Lifestyle behaviour and lifetime incidence of heart diseases

“…Observations of this type are sometimes defined as lifetime estimates although studies with complete extinction of the original cohorts are rare [19]. The Italian Rural Areas (IRA) of the Seven Countries of Cardiovascular Diseases have reached 50 years of follow-up and some reports on that duration have been already published [18,[20][21][22].…”