Key result
Adding SBP to DBP fails to improve 10-year cardiovascular event prediction in the general population.
Why the study?
Focus has shifted from diastolic to systolic blood pressure, but formal analyses of differences in predictive value are scarce.
Does adding systolic blood pressure to diastolic blood pressure improve the prediction of 10-year cardiovascular events and mortality in a general population cohort?
Cohort (n=2,097)
No
Does adding systolic blood pressure to diastolic blood pressure improve the prediction of 10-year cardiovascular events and mortality in a general population cohort?
For the average population, the 10-year discriminative ability for predicting cardiovascular death and events is not significantly improved by adding systolic to diastolic blood pressure.
Answers are grounded in this paper and cite their sources.
Adding SBP to DBP yields no meaningful gain in 10-year CV prediction; leaves open whether combined ambulatory metrics refine risk models.
Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24-h ambulatory SBP and 24-h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause-specific Cox regression was performed to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular (CV) events. Also, the time-dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer-May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24-h ambulatory SBP and 24-h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p-value) was .26% (-.2% to .73%; .27) for 10-year CV mortality and .69% (-.09% to 1.46%; .082) for 10-year risk of CV events. The difference in AUC was .12% (-.2% to .44%; .46) for 10-year CV mortality and .04% (-.35 to .42%; .85) for 10-year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were .078 and .077, respectively. Furthermore, the Brier scores were .077 and .078 in CV mortality and CV events of 24-h ambulatory. For the average population as those participating in a population survey, the 10-year discriminative ability for long-term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.
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Talebi et al. (2022) conducted a cohort in Cardiovascular risk (n=2,097). Adding systolic blood pressure to diastolic blood pressure vs. Diastolic blood pressure alone was evaluated on Difference in AUC for 10-year risk of cardiovascular events (adding 24-h ambulatory SBP to DBP) (Difference in AUC 0.69%, 95% CI -0.09 to 1.46, p=0.082). Adding systolic blood pressure to diastolic blood pressure did not significantly improve the 10-year discriminative ability for predicting cardiovascular death and events in a general population.
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