Cargando…

Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events

Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear. Methods: In this prospective study, conducted in the Kailuan community o...

Descripción completa

Detalles Bibliográficos
Autores principales: Zuo, Yingting, Zheng, Deqiang, Chen, Shuohua, Yang, Xinghua, Yan, Yuxiang, Liu, Fen, Tian, Xue, Wang, Meiping, Su, Xin, Wen, Jing, Zhai, Qi, Zhang, Yibo, Gaisano, Herbert Y., Wu, Shouling, Wang, Anxin, He, Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490882/
https://www.ncbi.nlm.nih.gov/pubmed/34621801
http://dx.doi.org/10.3389/fcvm.2021.735679
_version_ 1784578619107966976
author Zuo, Yingting
Zheng, Deqiang
Chen, Shuohua
Yang, Xinghua
Yan, Yuxiang
Liu, Fen
Tian, Xue
Wang, Meiping
Su, Xin
Wen, Jing
Zhai, Qi
Zhang, Yibo
Gaisano, Herbert Y.
Wu, Shouling
Wang, Anxin
He, Yan
author_facet Zuo, Yingting
Zheng, Deqiang
Chen, Shuohua
Yang, Xinghua
Yan, Yuxiang
Liu, Fen
Tian, Xue
Wang, Meiping
Su, Xin
Wen, Jing
Zhai, Qi
Zhang, Yibo
Gaisano, Herbert Y.
Wu, Shouling
Wang, Anxin
He, Yan
author_sort Zuo, Yingting
collection PubMed
description Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear. Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006–2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006–2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence. Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: <120/<80, 120–129/<80, 130–139/80–89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6–3.2 and 0.2–3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up. Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP.
format Online
Article
Text
id pubmed-8490882
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-84908822021-10-06 Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events Zuo, Yingting Zheng, Deqiang Chen, Shuohua Yang, Xinghua Yan, Yuxiang Liu, Fen Tian, Xue Wang, Meiping Su, Xin Wen, Jing Zhai, Qi Zhang, Yibo Gaisano, Herbert Y. Wu, Shouling Wang, Anxin He, Yan Front Cardiovasc Med Cardiovascular Medicine Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear. Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006–2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006–2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence. Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: <120/<80, 120–129/<80, 130–139/80–89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6–3.2 and 0.2–3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up. Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP. Frontiers Media S.A. 2021-09-21 /pmc/articles/PMC8490882/ /pubmed/34621801 http://dx.doi.org/10.3389/fcvm.2021.735679 Text en Copyright © 2021 Zuo, Zheng, Chen, Yang, Yan, Liu, Tian, Wang, Su, Wen, Zhai, Zhang, Gaisano, Wu, Wang and He. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Zuo, Yingting
Zheng, Deqiang
Chen, Shuohua
Yang, Xinghua
Yan, Yuxiang
Liu, Fen
Tian, Xue
Wang, Meiping
Su, Xin
Wen, Jing
Zhai, Qi
Zhang, Yibo
Gaisano, Herbert Y.
Wu, Shouling
Wang, Anxin
He, Yan
Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title_full Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title_fullStr Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title_full_unstemmed Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title_short Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events
title_sort baseline and cumulative blood pressure in predicting the occurrence of cardiovascular events
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490882/
https://www.ncbi.nlm.nih.gov/pubmed/34621801
http://dx.doi.org/10.3389/fcvm.2021.735679
work_keys_str_mv AT zuoyingting baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT zhengdeqiang baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT chenshuohua baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT yangxinghua baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT yanyuxiang baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT liufen baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT tianxue baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT wangmeiping baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT suxin baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT wenjing baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT zhaiqi baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT zhangyibo baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT gaisanoherberty baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT wushouling baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT wanganxin baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents
AT heyan baselineandcumulativebloodpressureinpredictingtheoccurrenceofcardiovascularevents