Key result
Hypertensive blood pressure trajectories were associated with increased mortality and incident CVD compared to optimal trajectories, but this was not maintained after extensive confounder adjustment.
Why the study?
The study aimed to determine sex differences in mid-life longitudinal SBP and DBP trajectories and their associations with mortality and incident CVD in old age.
Are sex-specific longitudinal blood pressure trajectories associated with mortality and incident cardiovascular disease in older age?
Cohort (n=6,716)
Are sex-specific longitudinal blood pressure trajectories associated with mortality and incident cardiovascular disease in older age?
Effective antihypertensive therapy may offset the adverse cardiovascular and mortality outcomes associated with prolonged exposure to high blood pressure trajectories in mid-life.
Sex-specific mid-life BP trajectories may refine long-term risk assessment; leaves open whether targeting them alters old-age outcomes.
AIMS: We aimed to determine the sex differences in longitudinal systolic and diastolic blood pressure (SBP and DBP) trajectories in mid-life and delineate the associations between these and mortality (all-cause, cardiovascular, and non-cardiovascular) and incident cardiovascular disease (CVD) in old age. METHODS AND RESULTS: Participants were selected from the European Prospective Investigation into Cancer, Norfolk (EPIC-Norfolk) cohort study. Sex-specific trajectories were determined using group-based trajectory models using three clinic BP measurements acquired between 1993 and 2012 (mean exposure ∼12.9 years). Multivariable Cox regressions determined the associations between trajectories and incident outcomes over the follow-up (median follow-up 9.4 years). A total of 2897 men (M) and 3819 women (F) were included. At baseline, women were younger (F-55.5, M-57.1), had a worse cardiometabolic profile and were less likely to receive primary CVD prevention including antihypertensive treatment (F-36.0%, M-42.0%). Over the exposure period, women had lower SBP trajectories while men exhibited more pronounced SBP decreases over this period. Over the follow-up period, women had lower mortality (F-11.9%, M-20.5%) and CVD incidence (F-19.8%, M-29.6%). Compared to optimal SBP (≤120 mmHg) and DBP (≤70 mmHg) trajectories, hypertensive trajectories were associated with increased mortality and incident CVD in both men and women during follow-up at univariable level. These associations were nevertheless not maintained upon extensive confounder adjustment including antihypertensive therapies. CONCLUSION: We report sex disparities in CVD prevention which may relate to worse cardiometabolic profiles and less pronounced longitudinal SBP decreases in women. Effective anti-hypertensivetherapy may offset the adverse outcomes associated with prolonged exposure to high blood pressure.
No takes yet. Share an insight, caveat, or question.
Pana et al. (2021) conducted a cohort in Hypertension (n=6,716). Hypertensive blood pressure trajectories vs. Optimal SBP (≤120 mmHg) and DBP (≤70 mmHg) trajectories was evaluated on Mortality (all-cause, cardiovascular, and non-cardiovascular) and incident cardiovascular disease (CVD). Hypertensive blood pressure trajectories were associated with increased mortality and incident CVD compared to optimal trajectories, but this was not maintained after extensive confounder adjustment.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: