Do other cardiovascular risk factors influence the impact of age on the association between blood pressure and mortality? the MORGAM Project

Julie K K Vishram, Anders Borglykke, Anne H. Andreasen, Jørgen Jeppesen, Hans Ibsen, Torben Jørgensen, Grazyna Broda, Luigi Palmieri, Simona Giampaoli, Chiara Donfrancesco, Frank Kee, Giuseppe Mancia, Giancarlo Cesana, Kari Kuulasmaa, Veikko Salomaa, Susana Sans, Jean Ferrieres, Abdonas Tamosiunas, Stefan Söderberg, Patrick McElduffDominique Arveiler, Andrzej Pajak, Michael H. Olsen

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To investigate age-related shifts in the relative importance of SBP and DBP as predictors of cardiovascular mortality and all-cause mortality and whether these relations are influenced by other cardiovascular risk factors. METHODS: Using 42 cohorts from the MORGAM Project with baseline between 1982 and 1997, 85772 apparently healthy Europeans and Australians aged 19-78 years were included. During 13.3 years of follow-up, 9.2% died (of whom 7.2% died due to stroke and 21.1% due to coronary heart disease, CHD). RESULTS: Mortality risk was analyzed using hazard ratios per 10-mmHg/5-mmHg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, SBP and DBP were analyzed separately for blood pressure (BP) values above and below a cut-point wherein mortality risk was the lowest. For the total population, significantly positive associations were found between stroke mortality and SBP [hazard ratio=1.19 (1.13-1.25)] and DBP at least 78mmHg [hazard ratio=1.08 (1.02-1.14)], CHD mortality and SBP at least 116mmHg [1.20 (1.16-1.24)], and all-cause mortality and SBP at least 120mmHg [1.09 (1.08-1.11)] and DBP at least 82mmHg [1.03 (1.02-1.05)]. BP values below the cut-points were inversely related to mortality risk. Taking into account the age×BP interaction, there was a gradual shift from DBP (19-26 years) to both DBP and SBP (27-62 years) and to SBP (63-78 years) as risk factors for stroke mortality and all-cause mortality, but not CHD mortality. The age at which the importance of SBP exceeded DBP was for stroke mortality influenced by sex, cholesterol, and country risk. CONCLUSION: Age-related shifts to the superiority of SBP exist for stroke mortality and all-cause mortality, and for stroke mortality was this shift influenced by other cardiovascular risk factors.

Original languageEnglish
Pages (from-to)1025-1033
Number of pages9
JournalJournal of Hypertension
Volume32
Issue number5
DOIs
Publication statusPublished - 2014

Keywords

  • age
  • blood pressure
  • epidemiology
  • mortality
  • risk factors

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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