Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort

Abstract

The objective of this study (follow-up of 26 113 people) was to investigate differences in the risk of cardiovascular disease (CVD) and all-cause mortality among hypertensive people according to the control of systolic blood pressure (SBP) and diastolic blood pressure (DBP). People with a history of coronary heart disease, heart failure, cancer or incomplete data at baseline (n=1113) were excluded from the study. The participants were classified into six groups according to their blood pressure status. Treated hypertensive individuals with controlled SBP and DBP did not experience an increase in all-cause mortality compared with normotensive people. The increase in all-cause mortality was 1.48-fold (95% confidence interval (CI) 1.09–2.01) among those who were treated with antihypertensive drugs and had only their DBP controlled and 1.45-fold (95% CI 1.04–2.02) among those who were treated and had only their SBP controlled. Treated patients with both SBP and DBP controlled did not have an increased risk of CVD mortality when compared with normotensive people. The risk of CVD mortality was statistically significantly higher in treated hypertensive people with SBP alone, DBP alone or both SBP and DBP uncontrolled. Our study indicates that uncontrolled SBP alone and DBP alone are risk factors of all-cause and CVD mortality.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA et al. Blood pressure, stroke and coronary heart disease. Part 2: short term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–839.

    Article  CAS  PubMed  Google Scholar 

  2. Boudik F, Reissigova J, Hrach K, Tomeckova M, Bultas J, Anger Z et al. Primary prevention of coronary artery disease among middle aged men in Prague: twenty-year follow-up results. Atherosclerosis 2006; 184: 86–93.

    Article  CAS  PubMed  Google Scholar 

  3. Lawes CM, Vander Hoorn S, Law MR, Elliott P, MacMahon S, Rodgers A . Blood pressure and the global burden of disease 2000. Part II: estimates of attributable burden. J Hypertens 2006; 24: 423–430.

    Article  CAS  PubMed  Google Scholar 

  4. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO . Morbidity and mortality in the Swedish Trial in Old Patients with hypertension (STOP-Hypertension). Lancet 1991; 338: 1281–1285.

    Article  PubMed  Google Scholar 

  5. Nielsen WB, Vestbo J, Jensen GB . Isolated systolic hypertension as a major risk factor for stroke and myocardial infarction and an unexploited source of cardiovascular prevention: a prospective population-based study. J Hum Hypertens 1995; 9: 175–180.

    CAS  PubMed  Google Scholar 

  6. Antikainen R, Jousilahti P, Tuomilehto J . Systolic blood pressure, isolated systolic hypertension and risk of coronary heart disease, strokes, cardiovascular disease and all-cause mortality in the middle-aged population. J Hypertens 1998; 16: 577–583.

    Article  CAS  PubMed  Google Scholar 

  7. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R and Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.

    Article  PubMed  Google Scholar 

  8. Ikeda A, Iso H, Yamagishi K, Inoue M, Tsugane S . Blood pressure and the risk of stroke, cardiovascular disease, and all-cause mortality among Japanese: the JPHC Study. Am J Hypertens 2009; 22: 273–280.

    Article  PubMed  Google Scholar 

  9. Gueyffier F, Boutitie F, Boissel JP, Pocock S, Coope J, Cutler J et al. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Ann Intern Med 1997; 126: 761–767.

    Article  CAS  PubMed  Google Scholar 

  10. Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA 1997; 277: 739–745.

    Article  CAS  PubMed  Google Scholar 

  11. Almgren T, Persson B, Wilhelmsen L, Rosengren A, Andersson OK . Stroke and coronary heart disease in treated hypertension — a prospective cohort study over three decades. J Intern Med 2005; 257: 496–502.

    Article  CAS  PubMed  Google Scholar 

  12. Wilhelmsen L, Berglund G, Elmfeldt D . The multifactor primary prevention trial in Göteborg, Sweden. Eur Heart J 1986; 7: 279–288.

    Article  CAS  PubMed  Google Scholar 

  13. Andersson OK, Almgren T, Persson B, Samuelsson O, Hedner T, Wilhelmsen L . Survival in treated hypertension: follow up study after two decades. Br Med J 1998; 317: 167–171.

    Article  CAS  Google Scholar 

  14. Clausen J, Jensen G . Blood pressure and mortality: an epidemiological survey with 10 years follow-up. J Hum Hypertens 1992; 6: 53–59.

    CAS  PubMed  Google Scholar 

  15. Barengo NC, Kastarinen M, Antikainen R, Nissinen A, Tuomilehto J . The effects of awareness and control of hypertension on cardiovascular and all-cause mortality in a community-based population. J Hum Hypertens 2009; 23: 808–816.

    Article  CAS  PubMed  Google Scholar 

  16. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

    Article  CAS  PubMed  Google Scholar 

  17. Casiglia E, Mazza A, Tikhonoff V, Pessina AC . Population-based studies improve outcome in hypertensive patients. Am J Hypertens 2002; 15: 605–608.

    Article  PubMed  Google Scholar 

  18. Trafford JA, Horn CR, O’Neal H, McGonigle R, Halford-Maw L, Evans R . Five year follow-up of effects of treatment of mild and moderate hypertension. Br Med J (Clin Res Ed) 1981; 282: 1111–1113.

    Article  CAS  Google Scholar 

  19. Benetos A, Thomas F, Bean K, Gautier S, Smulyan H, Guize L . Prognostic value of systolic and diastolic blood pressure in treated hypertensive men. Arch Intern Med 2002; 162: 577–581.

    Article  PubMed  Google Scholar 

  20. Harms LM, Schellevis FG, van Eijk JT, Donker AJ, Bouter LM . Cardiovascular morbidity and mortality among hypertensive patients in general practice: the evaluation of long-term systematic management. J Clin Epidemiol 1997; 50: 779–786.

    Article  CAS  PubMed  Google Scholar 

  21. Gudmundsson LS, Johannsson M, Thorgeirsson G, Sigfusson N, Sigvaldason H, Witteman JC . Hypertension control as predictor of mortality in treated men and women, followed for up to 30 years. Cardiovasc Drugs Ther 2005; 19: 227–235.

    Article  PubMed  Google Scholar 

  22. Bulpitt CJ, Palmer AJ, Fletcher AE, Beevers DG, Coles EC, Ledingham JG et al. Optimal blood pressure control in treated hypertensive patients. Report from the Department of Health Hypertension Care Computing Project (DHCCP). Circulation 1994; 90: 225–233.

    Article  CAS  PubMed  Google Scholar 

  23. Vartiainen E, Jousilahti P, Alfthan G, Sundvall J, Pietinen P, Puska P . Cardiovascular risk factor changes in Finland, 1972–1997. Int J Epidemiol 2000; 29: 49–56.

    Article  CAS  PubMed  Google Scholar 

  24. for the WHO MONICA Project, Tunstall-Pedoe H . The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 1988; 41: 105–114.

    Article  Google Scholar 

  25. Hu G, Jousilahti P, Barengo NC, Qiao Q, Lakka TA, Tuomilehto J . Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care 2005; 28: 799–805.

    Article  PubMed  Google Scholar 

  26. Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Jousilahti P . The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women. Int J Obes Relat Metab Disord 2005; 29: 894–902.

    Article  CAS  Google Scholar 

  27. Vartiainen E, Laatikainen T, Salomaa V, Jousilahti P, Peltonen M, Puska P . Sydäninfarkti- ja aivohalvausriskin arviointi FINRISKI-tutkimuksessa (The FINRISK FUNCTION: Estimation of the risk of coronary events and stroke in the Finnish population). Suomen Lääkärilehti 2007; 48: 4507–4513.

    Google Scholar 

  28. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–3264.

    Article  Google Scholar 

  29. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH et al. for Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350: 757–764.

    Article  CAS  PubMed  Google Scholar 

  30. Law MR, Morris JK, Wald NJ . Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kannel WB . Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol 2000; 85: 251–255.

    Article  CAS  PubMed  Google Scholar 

  32. Ong KL, Cheung BMY, Man CY, Lau CP, Lam KSL . Prevalence, awareness, treatment and control of hypertension among United States adults 1999–2004. Hypertension 2007; 49: 69–75.

    Article  CAS  PubMed  Google Scholar 

  33. Kastarinen M, Antikainen R, Peltonen M, Laatikainen T, Barengo NC, Jula A et al. Prevalence, awareness and treatment of hypertension in Finland during 1982–2007. J Hypertens 2009; 27: 1552–1559.

    Article  CAS  PubMed  Google Scholar 

  34. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

    Article  Google Scholar 

  35. Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C . Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study. Am J Hypertens 2006; 19: 243–250.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by a grant of the Finnish Foundation of Cardiovascular Research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N C Barengo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barengo, N., Antikainen, R., Kastarinen, M. et al. The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort. J Hum Hypertens 27, 693–697 (2013). https://doi.org/10.1038/jhh.2013.22

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.22

Keywords

This article is cited by

Search

Quick links