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A comparison of blood pressure indices as predictors of all-cause mortality among middle-aged men and women during 701,707 person-years of follow-up

Abstract

High systolic blood pressure (SBP) is often used as a measure of hypertension in epidemiological studies. Alternative blood pressure (BP) indices include diastolic blood pressure (DBP), pulse pressure (PP), mid-blood pressure (MBP) and mean arterial pressure (MAP). The present study compares the predictive ability for all-cause mortality (ACM) of these indices and the novel BP index mean proportional arterial pressure (MPAP), defined as the weighted mean of SBP and DBP where the weights are proportional to SBP’s and DBP’s contributions to the sum of SBP and DBP. Using a Swedish cohort of 32,238 middle-aged men and women, not being on antihypertensive treatment, examined in 1989–2000 and followed-up until March 9, 2017, the predictive abilities for ACM of SBP, DBP, PP, MBP, MAP and MPAP were compared using a likelihood-based R2-type measure for adjusted and unadjusted Cox regression models. Of the included participants (mean age 45.4 years, 48.2% men), 2936 (9.1%) died during a mean follow-up time of 21.8 years, equalling 701,707 person-years at risk. Higher BP were for all indices significantly associated with increased ACM. For all models, those including MPAP had the highest predictive ability, followed in turn by models including MBP, SBP, MAP, DBP and PP, respectively. The difference was significant for SBP, DBP and PP in unadjusted models and for PP in fully adjusted models. In conclusion, MPAP and MBP are the best predictors of ACM. Until the clinical usefulness of these indices has been evaluated, they may primarily be useful for epidemiological studies.

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References

  1. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–724.

    Article  Google Scholar 

  2. 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;360:1903–13.

    Article  Google Scholar 

  3. Mosley WJ, Greenland P, Garside DB, Lloyd-Jones DM. Predictive utility of pulse pressure and other blood pressure measures for cardiovascular outcomes. Hypertension. 2007;49:1256–64.

    CAS  Article  Google Scholar 

  4. Miura K, Dyer AR, Greenland P, Daviglus ML, Hill M, Liu K, et al. Pulse pressure compared with other blood pressure indexes in the prediction of 25-year cardiovascular and all-cause mortality rates: The Chicago Heart Association Detection Project in Industry Study. Hypertension. 2001;38:232–7.

    CAS  Article  Google Scholar 

  5. Lawes CM, Bennett DA, Parag V, Woodward M, Whitlock G, Lam TH, et al. Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis. Hypertension. 2003;42:69–75.

    Article  Google Scholar 

  6. Black WC, Haggstrom DA, Welch HG. All-cause mortality in randomized trials of cancer screening. J Natl Cancer Inst. 2002;94:167–73.

    Article  Google Scholar 

  7. Rosenblad A, Nilsson G, Leppert J. Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study. Eur J Epidemiol. 2012;27:647–55.

    Article  Google Scholar 

  8. Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24:659–67.

    Article  Google Scholar 

  9. Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaelsson K, Neovius M, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31:125–36.

    Article  Google Scholar 

  10. Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81:515–26.

    Article  Google Scholar 

  11. Austin PC, Pencinca MJ, Steyerberg EW. Predictive accuracy of novel risk factors and markers: a simulation study of the sensitivity of different performance measures for the Cox proportional hazards regression model. Stat Methods Med Res. 2017;26:1053–77.

    Article  Google Scholar 

  12. Carlsson AC, Johansson SE, Theobald H, Wandell PE. Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up. Blood Press Monit. 2013;18:72–7.

    Article  Google Scholar 

  13. Psaty BM, Furberg CD, Kuller LH, Cushman M, Savage PJ, Levine D, et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study. Arch Intern Med. 2001;161:1183–92.

    CAS  Article  Google Scholar 

  14. Kengne AP, Czernichow S, Huxley R, Grobbee D, Woodward M, Neal B, et al. Blood pressure variables and cardiovascular risk: new findings from ADVANCE. Hypertension. 2009;54:399–404.

    CAS  Article  Google Scholar 

  15. Socialstyrelsen [Swedish National Board of Health and Welfare]. Folkhälsorapport 2009. Stockholm, Sweden: Socialstyrelsen [Swedish National Board of Health and Welfare]; 2009. [Public Health Report 2009].

    Google Scholar 

Download references

Acknowledgements

The author thanks Dr Jerzy Leppert and Dr Emelie Condén for valuable discussions and suggestions. The study was supported by grants from the Västmanland County Council. Funding by this institution was not in any way associated with any conditions placed upon the design or execution of the study, neither with the interpretation of the results.

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Correspondence to Andreas Rosenblad.

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Rosenblad, A. A comparison of blood pressure indices as predictors of all-cause mortality among middle-aged men and women during 701,707 person-years of follow-up. J Hum Hypertens 32, 660–667 (2018). https://doi.org/10.1038/s41371-018-0085-7

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