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Original Article

Differential Influence of Distinct Components of Increased Blood Pressure on Cardiovascular Outcomes

From the Atherosclerosis Risk in Communities Study

Susan Cheng, Deepak K. Gupta, Brian Claggett, A. Richey Sharrett, Amil M. Shah, Hicham Skali, Madoka Takeuchi, Hanyu Ni, Scott D. Solomon
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https://doi.org/10.1161/HYPERTENSIONAHA.113.01561
Hypertension. 2013;HYPERTENSIONAHA.113.01561
Originally published July 22, 2013
Susan Cheng
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Deepak K. Gupta
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Brian Claggett
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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A. Richey Sharrett
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Amil M. Shah
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Hicham Skali
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Madoka Takeuchi
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Hanyu Ni
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Scott D. Solomon
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.C., D.K.G., B.C., A.M.S., H.S., M.T., S.D.S.); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (A.R.S.); and National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (H.N.).
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Abstract

Elevation in blood pressure (BP) increases risk for all cardiovascular events. Nevertheless, the extent to which different indices of BP elevation may be associated to varying degrees with different cardiovascular outcomes remains unclear. We studied 13 340 participants (aged 54±6 years, 56% women and 27% black) of the Atherosclerosis Risk in Communities Study who were free of baseline cardiovascular disease. We used Cox proportional hazards models to compare the relative contributions of systolic BP, diastolic BP, pulse pressure, and mean arterial pressure to risk for coronary heart disease, heart failure, stroke, and all-cause mortality. For each multivariable-adjusted model, the largest area under the receiver-operating curve (AUC) and smallest −2 log-likelihood values were used to identify BP measures with the greatest contribution to risk prediction for each outcome. A total of 2095 coronary heart disease events, 1669 heart failure events, 771 stroke events, and 3016 deaths occurred during 18±5 years of follow-up. In multivariable analyses adjusting for traditional cardiovascular risk factors, the BP measures with the greatest risk contributions were the following: systolic BP for coronary heart disease (AUC=0.74); pulse pressure for heart failure (AUC=0.79); systolic BP for stroke (AUC=0.74); and pulse pressure for all-cause mortality (AUC=0.74). With few exceptions, results were similar in analyses stratified by age, sex, and race. Our data indicate that distinct BP components contribute variably to risk for different cardiovascular outcomes.

  • blood pressure
  • cardiovascular diseases
  • epidemiology
  • hypertension
  • outcomes assessment
  • Received April 13, 2013.
  • Revision received April 28, 2013.
  • Accepted July 3, 2013.
  • © 2013 American Heart Association, Inc.
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    Differential Influence of Distinct Components of Increased Blood Pressure on Cardiovascular Outcomes
    Susan Cheng, Deepak K. Gupta, Brian Claggett, A. Richey Sharrett, Amil M. Shah, Hicham Skali, Madoka Takeuchi, Hanyu Ni and Scott D. Solomon
    Hypertension. 2013;HYPERTENSIONAHA.113.01561, originally published July 22, 2013
    https://doi.org/10.1161/HYPERTENSIONAHA.113.01561

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    Differential Influence of Distinct Components of Increased Blood Pressure on Cardiovascular Outcomes
    Susan Cheng, Deepak K. Gupta, Brian Claggett, A. Richey Sharrett, Amil M. Shah, Hicham Skali, Madoka Takeuchi, Hanyu Ni and Scott D. Solomon
    Hypertension. 2013;HYPERTENSIONAHA.113.01561, originally published July 22, 2013
    https://doi.org/10.1161/HYPERTENSIONAHA.113.01561
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