Associations of blood pressure components with risks of cardiovascular events and all‐cause death in a Chinese population: A Prospective Study

Q: What are the key findings of this study?

Pulse pressure showed a J-shaped association with cardiovascular events, with highest risk at PP ≥72.5 mmHg (HR 2.13, 95% CI 1.32-3.43) and <50 mmHg (HR 1.71, 95% CI 1.03-2.85) vs 50-60 mmHg.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Community-dwelling individuals without a history of cardiovascular disease (n=1257). Intervention: Blood pressure components (SBP, DBP, and pulse pressure [PP]; wide PP ≥60 mmHg or quartile ≥72.5 mmHg) vs. Reference blood pressure groups (e.g., PP 50-60 mmHg or PP <60 mmHg). Primary outcome: Composite of cardiovascular events (coronary events, stroke events, and peripheral vascular surgery) (HR 2.13, 95% CI 1.32-3.43, p=<0.05).

Q: What does this research mean for the field?

Pulse pressure exhibits a J-shaped association with cardiovascular events, where risks increase at levels below 50 mmHg and above 60 mmHg compared to the lowest-risk range of 50–60 mmHg. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate how systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) contribute to cardiovascular events and all-cause mortality, and determine optimal cutoff points for wide PP.

Zhongying Zhang; Xiang Gu; Zhe Tang; Shaochen Guan; Hongjun Liu; Xiaoguang Wu; Yan Zhao; Xianghua Fang

doi:10.1111/jch.14529

June 24, 2022Journal of Clinical HypertensionOpen Access

Associations of blood pressure components with risks of cardiovascular events and all‐cause death in a Chinese population: A Prospective Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Pulse pressure shows a J-shaped curve, with PP ≥72.5 mmHg linked to ~2.1-fold higher CV risk.

HR 2.13
95% CI 1.32-3.43
P<0.05
n=1,257

Figures

Why the study?

The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure is still controversial.

How do blood pressure components (SBP, DBP, and pulse pressure) associate with the risks of incident cardiovascular events and all-cause death across age groups in a community-dwelling Chinese population without prior cardiovascular disease?

Key Points

To evaluate how systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) contribute to cardiovascular events and all-cause mortality, and determine optimal cutoff points for wide PP.
Prospective cohort study of 1257 Chinese community-dwelling participants without baseline cardiovascular disease followed for 4.84 years (6,081.8 person-years).
Multivariable Cox regression models adjusted for age, sex, smoking, alcohol use, diabetes mellitus, dyslipidemia, hsCRP, eGFR, and antihypertensive treatment.
Receiver-operating characteristic (ROC) curves and Youden's index were utilized to establish optimal cutoff values of wide PP for predicting adverse outcomes.
Across all participants, SBP and PP were significantly associated with cardiovascular events and all-cause death (all p < .05), whereas DBP showed only a marginally significant association with cardiovascular events (HR: 1.01, 95% CI: 1.00–1.03, p = 0.051) and no significant association with death.
Pulse pressure displayed a J-shaped relationship with cardiovascular events compared to the 50–60 mmHg reference range, with adjusted HRs of 1.71 (95% CI: 1.03–2.85) for <50 mmHg, 1.63 (95% CI: 1.00–2.68) for 60.0–72.5 mmHg, and 2.13 (95% CI: 1.32–3.43) for ≥72.5 mmHg.
In participants aged <65 years, DBP independently increased cardiovascular event risk (HR: 1.03, 95% CI: 1.01–1.06), and optimal cutoff values of wide PP were 70.25 mmHg for cardiovascular events and 76.25 mmHg for all-cause death.

Study Design

Type

Cohort (n=1,257)

Multicenter

Yes

Structured PICO

How do blood pressure components (SBP, DBP, and pulse pressure) associate with the risks of incident cardiovascular events and all-cause death across age groups in a community-dwelling Chinese population without prior cardiovascular disease?

P

Population

1,257 community-dwelling Chinese adults (mean age 69.16 years, 56.24% female) free of prior cardiovascular disease, followed for an average of 4.84 years.

E

Exposure

Elevated or altered blood pressure components: systolic blood pressure (SBP), diastolic blood pressure (DBP), continuous pulse pressure (PP), wide PP (defined as ≥60 mmHg or ≥100 mmHg), and PP quartiles (<50, 60.0-72.5, and ≥72.5 mmHg).

C

Comparator

Lower or reference blood pressure categories (e.g., lowest-risk PP reference group of 50-60 mmHg, or PP <60 mmHg).

O

Outcome

Composite of cardiovascular events (fatal or non-fatal myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, sudden cardiac death, fatal or non-fatal ischemic or hemorrhagic stroke, and peripheral vascular surgery) over a mean follow-up of 4.84 years.composite

Main Result

Hazard Ratio: 2.13 (95% CI 1.32–3.43)

p-value: p=<0.05

Limitations

Relatively small sample size prevented separate analysis of coronary and stroke events.
Selection bias due to 1010 participants (43.84%) refusing to provide blood samples.
Lack of data on blood pressure levels, antihypertensive medication changes, and newly identified risk factors during follow-up.
Relatively short follow-up time (4.84 years) for lower-risk middle-aged participants.
Participants with severe aortic regurgitation or stenosis were not excluded due to lack of echocardiography.
Relatively small sample size precluded separate analysis of coronary events and stroke events.
Selection bias from excluding 1010 participants (43.84%) who refused to provide blood samples and 37 (1.61%) with missing information.
Lack of follow-up data on longitudinal blood pressure levels, antihypertensive medication adjustments, and newly identified risk factors.
Relatively short follow-up period for assessing risk in middle-aged participants.
Echocardiographic examinations were not performed to exclude severe aortic regurgitation or stenosis.

Implication

In community-dwelling Chinese adults without prior cardiovascular disease, SBP and pulse pressure (following a J-shaped curve with lowest risk at 50-60 mmHg) drive cardiovascular and mortality risk in older adults, whereas DBP independently predicts cardiovascular events in middle-aged adults (<65 years).

Abstract

The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all-cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all-cause death (all p < .05). DBP was not significantly associated with the risk of all-cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01-1.06). The association between PP and cardiovascular events appeared to be J-shaped in comparison to participants with the lowest-risk PP (50-60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03-2.85), 1.63 (95% CI: 1.00-2.68), and 2.13 (95% CI: 1.32-3.43) in the <50, 60.0-72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all-cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle-aged participants. Considerable PP alterations should be avoided in antihypertensive treatment.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Zhang et al. (2022) conducted a cohort in Community-dwelling individuals without a history of cardiovascular disease (n=1,257). Blood pressure components (SBP, DBP, and pulse pressure [PP]; wide PP ≥60 mmHg or quartile ≥72.5 mmHg) vs. Reference blood pressure groups (e.g., PP 50-60 mmHg or PP <60 mmHg) was evaluated on Composite of cardiovascular events (coronary events, stroke events, and peripheral vascular surgery) (HR 2.13, 95% CI 1.32-3.43, p=<0.05). Pulse pressure showed a J-shaped association with cardiovascular events, with highest risk at PP ≥72.5 mmHg (HR 2.13, 95% CI 1.32-3.43) and <50 mmHg (HR 1.71, 95% CI 1.03-2.85) vs 50-60 mmHg.

synapsesocial.com/papers/6a7a2b068a3ae1c74232a0b0 https://doi.org/10.1111/jch.14529

View Full Paper

Ask AI

Bookmark

Share

Associations of blood pressure components with risks of cardiovascular events and all‐cause death in a Chinese population: A Prospective Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Associations of blood pressure components with risks of cardiovascular events and all‐cause death in a Chinese population: A Prospective Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading