Blood pressure indices for predicting incident cardiovascular disease: A 13-year follow-up study in Japanese population

Background: Several blood pressure (BP) indices have been associated with incident cardiovascular disease (CVD); however, evidence comparing their long-term prognostic value in Asian populations is limited. We investigated the association between multiple BP indices and CVD risk over a 13-year follow-up period in a large Japanese population. Methods: Data from a health check-up program conducted by the Panasonic Corporation covering 166 operational sites from 2008 to 2021, including 163,956 participants not receiving anti-hypertensive drugs, were analyzed. The primary outcome was the incidence of three-point major adverse cardiac events (MACE), including cardiovascular death, nonfatal coronary artery disease, and nonfatal stroke. Cox proportional hazards models and time-dependent receiver operating characteristic (ROC) analyses were used to evaluate the associations between the four BP indices (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean arterial pressure [MAP]) and incident MACE. Results: After adjusting for confounders, all four BP indices were found to be independently associated with incident MACE. Among them, MAP demonstrated the highest area under the ROC curve for predicting MACE. In the gender-stratified analyses, the findings in males were broadly consistent with the overall results, whereas the predictive advantage of MAP was attenuated in females. Similarly, in analyses restricted to participants aged ≥50 years, the superiority of the MAP was less evident. Conclusions: MAP was the strongest predictor of incident CVD in the Japanese population. These findings underscore the importance of BP phenotyping and suggest that gender and age may modify the utility of MAP in cardiovascular risk stratification.