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Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk

Abstract

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18–65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP490 mmHg) or transient hypertensive (both DBP4<90 mmHg) status. Transients (n=850) were matched with normotensive controls (n=824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n=20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P=0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P=0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6–11.1]) and female patients (2.4 [1.0–5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR=5.1, P=0.04) and stroke (adj OR 15.9, P=0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

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Acknowledgements

We acknowledge the work of the following doctors whose practices formed the GP Hypertension Study Group: I Bradley (Pontesbury), G Dyker (East Kilbride), P Ganvir (Manchester), N Gostick (Rugby), SR Mayhew (East Socon), F Shepherd (Southall), F Wells (Ipswich), L Williams (Darlington). We also thank their nursing colleagues who performed much of the clinical work of the study, the patients who participated and Ciba-Geigy for administering the initial screening program. CJB was in receipt of a grant from the Bristol Heart Foundation for this analysis.

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Wingfield, D., Grodzicki, T., Palmer, A. et al. Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens 19, 347–354 (2005). https://doi.org/10.1038/sj.jhh.1001825

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  • DOI: https://doi.org/10.1038/sj.jhh.1001825

Keywords

  • transient hypertension
  • white-coat effect
  • cardiovascular risk

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