Study Examines Predictive Value of Cumulative Blood Pressure for CVD and All-Cause Mortality

According to new research, increases in cumulative blood pressure (cumBP) and cumulative diastolic blood pressure (cumDBP) are predictors of higher risk for all-cause mortality, cardiovascular and cerebrovascular events, and stroke, and blood pressure should be controlled within the desired range for middle-aged and older patients without hypertension.

Noting that the predictive value of cumulative blood pressure on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has "hardly been studied," investigators conducted a prospective cohort study that included 52,385 participants from the Kailuan Group, without CCE, who had had attended 3 medical examinations.
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From 2006 to 2007, a general medical examination was carried out for the serving and retired employees of the Kailuan Group by 11 hospitals in Kailuan (Hebei, China). Subsequent medical examinations took place in 2008–2009, 2010–2011, and 2012–2013.

Participants were eligible if they were in the first, second, and third examination; age 18 or older, had records of blood pressure measurements for all 3 examinations, had agreed to participate, and provided written informed consent.

The authors found that “for every 10 mm HG per year increase in cumSBP and 5 mm HG per year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029),” and that cumSBP and cumDBP were better predictors for all-cause mortality, CCEs, and stroke than baseline SBP or baseline DBP. However, baseline SBP was found to be a risk factor for myocardial infarction.

"We have found that with increases in cumSBP and cumDBP, the risk for all-cause mortality, cardiovascular and cerebrovascular events, and stroke also increased," the authors wrote, adding that there is "substantial potential gain by prevention or delay of hypertension" even with successful treatment.

"Therefore, for middle-aged and elder people who do not have hypertension, their blood pressure should be controlled within the desired range and should remain not elevated to keep cumSBP and cumDBP at a low level. For the management of hypertension in middle-aged and elder people, long-term effectiveness is as important as lowering the elevated blood pressure to within the normal range. The aim of blood pressure control is to reduce the risk for cardiovascular and cerebrovascular events and all-cause mortality caused by consistent high blood pressure, and to improve the quality of life of the patient."

—Mark McGraw

References:

Wang YX, Song L, Xing AJ, et al. Predictive value of cumulative blood pressure for all-cause mortality and cardiovascular events [published online February 7, 2017]. Scientific Reports. doi:10.1038/srep41969.