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

Journal of Human Hypertension volume 32, pages 585–593 (2018)Cite this article

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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.

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References

  1. Johnson JN, Hornik CP, Li JS, Benjamin DK Jr., Yoshizumi TT, Reiman RE, et al. Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation. 2014;130:161–7.

    Article  Google Scholar 

  2. Wong JY, De Vivo I, Lin X, Christiani DC. Cumulative PM(2.5) exposure and telomere length in workers exposed to welding fumes. J Toxicol Environ Health A. 2014;77:441–55.

    Article  CAS  Google Scholar 

  3. Zemaitis P, Liu K, Jacobs DR Jr., Cushman M, Durazo-Arvizu R, Shoham D, et al. Cumulative systolic BP and changes in urine albumin-to-creatinine ratios in nondiabetic participants of the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol. 2014;9:1922–9.

    Article  Google Scholar 

  4. Navar-Boggan AM, Peterson ED, D’Agostino RB Sr., Neely B, Sniderman AD, Pencina MJ. Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease. Circulation. 2015;131:451–8.

    Article  CAS  Google Scholar 

  5. Sesso HD, Stampfer MJ, Rosner B, Hennekens CH, Gaziano JM, Manson JE, et al. Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men. Hypertension. 2000;36:801–7.

    Article  CAS  Google Scholar 

  6. Miura K, Nakagawa H, Ohashi Y, Harada A, Taguri M, Kushiro T, et al. Four blood pressure indexes and the risk of stroke and myocardial infarction in Japanese men and women: a meta-analysis of 16 cohort studies. Circulation. 2009;119:1892–8.

    Article  Google Scholar 

  7. Zheng L, Sun Z, Li J, Zhang R, Zhang X, Liu S, et al. Pulse pressure and mean arterial pressure in relation to ischemic stroke among patients with uncontrolled hypertension in rural areas of China. Stroke. 2008;39:1932–7.

    Article  Google Scholar 

  8. Strandberg TE, Salomaa VV, Vanhanen HT, Pitkala K, Miettinen TA. Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years. J Hypertens. 2002;20:399–404.

    Article  CAS  Google Scholar 

  9. Wang F, Wu S, Song Y, Tang X, Marshall R, Liang M, et al. Waist circumference, body mass index and waist to hip ratio for prediction of the metabolic syndrome in Chinese. Nutr Metab Cardiovasc Dis. 2009;19:542–7.

    Article  CAS  Google Scholar 

  10. Wu S, Li Y, Jin C, Yang P, Li D, Li H, et al. Intra-individual variability of high-sensitivity C-reactive protein in Chinese general population. Int J Cardiol. 2012;157:75–9.

    Article  CAS  Google Scholar 

  11. Wu S, Huang Z, Yang X, Zhou Y, Wang A, Chen L, et al. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city. Circ Cardiovasc Qual Outcomes. 2012;5:487–93.

    Article  Google Scholar 

  12. Song Q, Liu X, Wang X, Wu S. Age- and gender-specific associations between sleep duration and incident hypertension in a Chinese population: the Kailuan study. J Hum Hypertens. 2016;30:503–7.

    Article  CAS  Google Scholar 

  13. Li W, Jin C, Vaidya A, Wu Y, Rexrode K, Zheng X, et al. Blood pressure trajectories and the risk of intracerebral hemorrhage and cerebral infarction: a prospective study. Hypertension. 2017;70:508–14.

    Article  CAS  Google Scholar 

  14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  Google Scholar 

  15. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90:583–612.

    Article  CAS  Google Scholar 

  16. Stroke—1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke. 1989;20:1407–31.

  17. Zhang Q, Zhou Y, Gao X, Wang C, Zhang S, Wang A, et al. Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke. Stroke. 2013;44:2451–6.

    Article  Google Scholar 

  18. Bangalore S, Schwamm L, Smith EE, Hellkamp AS, Suter RE, Xian Y, et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. Eur Heart J. 2017;38:2827–35.

    Article  Google Scholar 

  19. Boutitie F,Gueyffier F,Pocock S,Fagard R,Boissel JP,intervention IPSCIDAoA. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med. 2002;136:438–48.

    Article  Google Scholar 

  20. Wang YX, Song L, Xing AJ, Gao M, Zhao HY, Li CH, et al. Predictive value of cumulative blood pressure for all-cause mortality and cardiovascular events. Sci Rep. 2017;7:41969.

    Article  CAS  Google Scholar 

  21. Avanzini F, Alli C, Boccanelli A, Chieffo C, Franzosi MG, Geraci E, et al. High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction. J Hypertens. 2006;24:2377–85.

    Article  CAS  Google Scholar 

  22. Tuomilehto J, Ryynanen OP, Koistinen A, Rastenyte D, Nissinen A, Puska P. Low diastolic blood pressure and mortality in a population-based cohort of 16913 hypertensive patients in North Karelia, Finland. J Hypertens. 1998;16:1235–42.

    Article  CAS  Google Scholar 

  23. Fuchs FD, Fuchs SC. Blood pressure targets in the treatment of high blood pressure: a reappraisal of the J-shaped phenomenon. J Hum Hypertens. 2014;28:80–4.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all study participants, their relatives, and the members of the survey teams at the 11 hospitals affiliated to the Kailuan community.

Funding

We thank the support funding from National Basic Research Program of China (973 Program, 2014CB542302), CAMS Innovation Fund for Medical Sciences (CIFMS), National Natural Science Foundation of China (81470541, 81630014), Beijing Municipal Science and Technology Commission (Z151100002115050, Z151100004015176), and Beijing Municipal Commission of Education (KZ201610025028).

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Author notes

  1. These authors contributed equally: Xiao Cui, Quanhui Zhao.

Authors and Affiliations

  1. State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiao Cui & Jun Cai

  2. Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China

    Quanhui Zhao, Junxing Yu, Ruiying Zhang, Wei Li, Lu Song, Chunhui Li, Hualing Zhao & Shouling Wu

  3. Graduate School, North China University of Science and Technology, Tangshan, China

    Quanhui Zhao, Junxing Yu, Ruiying Zhang, Wei Li, Lu Song, Chunhui Li & Hualing Zhao

  4. Department of Surgery, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China

    Aiping Wu

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  1. Xiao Cui
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Correspondence to Shouling Wu or Jun Cai.

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Cui, X., Zhao, Q., Yu, J. et al. Cumulative mean arterial pressure and risks of adverse cardiac and cerebrovascular events: a prospective cohort study of 53,813 adults. J Hum Hypertens 32, 585–593 (2018). https://doi.org/10.1038/s41371-018-0075-9

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