Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population

Abstract

Background: Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old. Methods: 6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke. Results: During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05–1.20, HR, 1.14; 95%, 1.07–1.22, HR, 1.14; 95%, 1.07–1.22), heart disease (HR, 1.05; 95%, 0.97–1.13, HR, 1.09; 95%, 1.01–1.17, HR, 1.08; 95%, 1.00–1.16) and stroke (HR, 1.35; 95%, 1.21–1.51, HR, 1.31; 95%, 1.17–1.46, HR, 1.36; 95%, 1.22–1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10–1.38). None nonlinear relationships were identified (p-nonlinear >.05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p