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

Journal of Human Hypertension volume 19, pages 347–354 (2005)Cite this article

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 DBP4⩾90 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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Authors and Affiliations

  1. Brook Green Medical Centre, Bute Gardens, London, UK

    D Wingfield

  2. Department of Internal Medicine and Gerontology, Jagiellonian University, Cracow, Poland

    T Grodzicki

  3. Section of Geriatric Medicine, Imperial College, Hammersmith Hospital, London, UK

    A J Palmer & C J Bulpitt

  4. Member of the General Practice Hypertension Study Group,

    F Wells

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  1. D Wingfield
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  2. T Grodzicki
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  3. A J Palmer
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  4. F Wells
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  5. C J Bulpitt
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on behalf of the General Practice Hypertension Study Group

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Correspondence to D Wingfield.

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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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Keywords

  • transient hypertension
  • white-coat effect
  • cardiovascular risk

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