Key result
Elevated-stable (HR 1.75; 95% CI 1.33-2.32) and moderate-stable (HR 1.32; 95% CI 1.12-1.56) systolic blood pressure trajectories were associated with increased all-cause death versus low-stable SBP.
Why the study?
Do higher SBP trajectories increase the risk of all-cause death in Chinese adults without prior myocardial infarction, stroke, or cancer?
Cohort (n=84,363)
Do higher SBP trajectories increase the risk of all-cause death in Chinese adults without prior myocardial infarction, stroke, or cancer?
Hazard Ratio: 1.75 (95% CI 1.33–2.32)
Long-term systolic blood pressure trajectories, even those within the currently designated 'normal' range, are associated with an increased risk of all-cause mortality.
SBP trajectories, even within normal range, were associated with higher all-cause mortality; leaves open whether monitoring them improves risk stratification or outcomes.
OBJECTIVE: This study aimed to investigate whether long-term trajectories of high SBP can further predict risk of all-cause death in Chinese adults. METHODS: We used a community-based cohort of 84 363 participants without myocardial infarction, stroke, or cancer, in 2010. SBP trajectories used latent mixture modeling with data from 2006, 2008, and 2010. Cox proportional hazards models were used to examine the association between SBP trajectories and risk of all-cause death in 2010-2015. RESULTS: We identified five distinct SBP trajectory patterns based on the 2006 status and the pattern of change during 2006-2010. Each pattern was labeled according to the SBP levels and pattern over time: low-stable (n = 21 249), moderate-stable (n = 39 390), moderate-increasing (n = 9634), elevated-decreasing (n = 9094) and elevated-stable (n = 4996). During 5.24 ± 1.04 years of follow-up, we documented 4131 deaths. After adjusting for potential confounding factors and using the low-stable group as a reference, hazard ratios [95% confidence interval (CI)] of all-cause death for the moderate-stable, moderate-increasing, elevated-decreasing, and elevated-stable groups were 1.32 (1.12-1.56), 1.60 (1.26-2.04), 1.69 (1.38-2.07), and 1.75 (1.33-2.32), respectively. Although the moderate-stable trajectory exhibited SBP ranges within the 'normal' range (126.90-130.09 mmHg) in 2006-2010, this group had higher all-cause death risk relative to the low-stable trajectory group (109.86-112.46 mmHg) (adjusted hazard ratio = 1.32, 95% CI 1.12-1.56). CONCLUSION: High SBP trajectories are independent risk factors for all-cause death. Our findings suggest increasing SBP trajectories within the currently designated 'normal' range may still increase risk of all-cause death.
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Wang et al. (2018) conducted a cohort in General population (n=84,363). High systolic blood pressure trajectories vs. Low-stable systolic blood pressure trajectory was evaluated on All-cause death (HR 1.75, 95% CI 1.33-2.32). Elevated-stable (HR 1.75; 95% CI 1.33-2.32) and moderate-stable (HR 1.32; 95% CI 1.12-1.56) systolic blood pressure trajectories were associated with increased all-cause death versus low-stable SBP.
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