Key result
Hypertension linked to ~3.1-fold higher risk of aortic dissection in a dose-dependent pattern.
Why the study?
Few prospective studies have investigated the association between hypertension or elevated blood pressure and aortic dissection incidence and mortality.
Does hypertension or elevated blood pressure increase the risk of aortic dissection incidence and mortality in the general population?
Meta-Analysis (n=4,563,501)
Yes
Does hypertension or elevated blood pressure increase the risk of aortic dissection incidence and mortality in the general population?
Relative Risk: 3.07 (95% CI 2.15–4.38)
Hypertension and elevated blood pressure exhibit a strong, positive, dose-dependent relationship with the risk of aortic dissection incidence and mortality, beginning even within the normal blood pressure range (>132/75 mm Hg).
Hypertension was associated with higher AD risk in large cohorts; leaves open whether BP lowering prevents events in trials.
Background: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies on this topic have been published. We investigated the association between hypertension/elevated BP and AD in 2 cohorts and conducted a meta-analysis of published prospective studies, including these 2 studies. Methods: We analyzed data from the J-SHC study (Japan-Specific Health Checkups) and UK Biobank, which prospectively followed up 534 378 and 502 424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks were calculated with random-effects models. A potential nonlinear dose-response relationship between BP and AD was tested with fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. Results: In the J-SHC study and UK Biobank, there were 84 and 182 ADs during the 4- and 9-year follow-up, and the adjusted hazard ratios of AD were 3.57 (95% CI, 2.17–6.11) and 2.68 (95% CI, 1.78–4.04) in hypertensive individuals, 1.33 (95% CI, 1.05–1.68) and 1.27 (95% CI, 1.11–1.48) per 20–mm Hg increase in systolic BP (SBP), and 1.67 (95% CI, 1.40–2.00) and 1.66 (95% CI, 1.46–1.89) per 10-mm Hg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary relative risks were 3.07 (95% CI, 2.15–4.38, I 2 =76.7%, n=7 studies, 2818 ADs, 4 563 501 participants) for hypertension and 1.39 (95% CI, 1.16–1.66, I 2 =47.7%, n=3) and 1.79 (95% CI: 1.51–2.12, I 2 = 57.0%, n=3) per 20–mm Hg increase in SBP and per 10–mm Hg increase in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mm Hg and DBP >75 mm Hg. Conclusions: Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD.
No takes yet. Share an insight, caveat, or question.
A 2021 study conducted a meta-analysis in Aortic dissection (n=4,563,501). Hypertension and elevated blood pressure vs. Normal blood pressure was evaluated on Aortic dissection incidence and mortality (RR 3.07, 95% CI 2.15-4.38). Hypertension was associated with a significantly increased risk of aortic dissection (RR 3.07; 95% CI 2.15-4.38), demonstrating a positive dose-dependent relationship even within the normal BP range.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: