Pretreatment blood pressure as a predictor of 21-year mortality

Department of Veterans Affairs Medical Center and the Washington University School of Medicine, St. Louis, Missouri, USA.
American Journal of Hypertension (Impact Factor: 2.85). 07/2000; 13(6 Pt 1):724-33. DOI: 10.1016/S0895-7061(99)00214-9
Source: PubMed


Our objective was to evaluate pretreatment predictors of longevity, particularly blood pressure, in a large cohort of hypertensive men. During 1974 to 1976, 10,367 male hypertensive veterans (47% black) were identified at screening and subsequently characterized in 32 special Veterans Administration (VA) hypertension clinics. Their mean age was 52 years and mean blood pressure (BP) 154/100 mm Hg. During an average of 21 years of follow-up, 61% died. Risk ratios for all-cause mortality as functions of BP and other risk factors are presented for each variable alone; for each variable controlling for age, race, and BP; and for a multivariate model. We observed that when the entire cohort was divided into deciles by systolic blood pressure (SBP) and by diastolic blood pressure (DBP), the risk ratios for 21-year mortality increased from lowest to highest decile by 178% for SBP and 16% for DBP. When the deciles were computed separately by age group, increases from lowest to highest decile for those less than 40 years of age were 138% for SBP and 263% for DBP. For those over 60 years, the increases were 154% and -10%, respectively. Although blacks were younger and had more severe diastolic hypertension than whites, the risk ratios were similar within each race group. Risk patterns for mean arterial pressure and pulse pressure resembled those for SBP but had smaller gradients. Survival curves for BP groups suggested constant mortality rates during follow-up. Other significant observations included decreasing mortality with increasing body mass index and increased mortality in the Stroke Belt. We concluded that pretreatment SBP strongly predicted all-cause mortality during 21-year follow-up. For the young, both SBP and DBP were strong predictors; for the elderly, only SBP was predictive.

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    • "The high rate of isolated systolic high BP (39%), as well as elevated systolic along with elevated diastolic blood pressure (53%) in the obese adolescents in this study is alarming. In adults, isolated systolic hypertension was found to pose a strong and independent risk of cardiovascular mortality [21], with isolated systolic hypertension being more associated than isolated diastolic hypertension with risk of coronary heart disease, stroke and end-stage renal disease [22]. A relatively recent systematic review and meta-regression analysis study that examined the tracking of blood pressure (BP) from childhood to adulthood has confirmed that childhood BP is associated with BP in later life [23]. "
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    ABSTRACT: A relationship between blood pressure (BP) and obesity has been found in young adults, but no data are available for adolescents in Kuwait. 257 adolescent (11-19 years) participants were categorized into two groups according to their BMI; 48 nonobese (21 males: 43.7% and 27 females: 56.3%) with mean age of 15.61 ± 2.40 years and 209 obese (128 males: 61.25% and 81 females: 38.75%) with mean age of 15.02 ± 2.82 years. The mean BMI was 21.7 ± 2.23 kg/m(2) for the nonobese group and 34.47 ± 4.70 kg/m(3) for the obese group. Most BP measures based on a single screening were significantly higher in the obese group. The prevalence of elevated BP was significantly higher in the obese subjects (nonobese: 13%; obese: 63%; P < 0.0001). In the obese group, there was a significant positive correlation between total sample BMI and all BP measures except the pulse pressure. There was a similar rate of elevated blood pressure between males and females (64% versus 60%; P = 0.66). For both isolated systolic elevated BP and isolated diastolic elevated BP, the prevalences were comparable between the males (systolic: 42%; diastolic: 5%) and females (systolic: 34%; diastolic: 14%). Only systolic BP was positively correlated with BMI in obese adolescent males (Spearman r = 0.18; P < 0.05), with a significant correlation between BMI with diastolic (Spearman r = 0.22; P < 0.05) and mean BP (Spearman r = 0.21; P < 0.05) in females.
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    ABSTRACT: A major invitational hypertension meeting was hosted by the Department of Veterans Affairs (VA) in Washington, DC, on May 26 to 28, 1999. It followed a report that only 25% of hypertensive veterans had adequate levels of treated blood pressure and focused on how control of hypertension could be improved both immediately and in the future. After the presentation of brief outlines of 5 unresolved basic science questions, 2 general topics were considered: (1) 30 years of change in hypertension and its treatment and (2) current healthcare delivery mechanisms and how to improve them. Since 1970, the severity of hypertension has decreased, malignant hypertension has disappeared, and the prognostic roles of systolic and diastolic blood pressure have been reversed as hypertension became milder. Five VA Cooperative Studies have provided important data: the 1970 Freis Trial report demonstrated the value of treatment, 2 trials showed that some controlled patients can decrease or even discontinue pharmacological treatment without recrudescent hypertension, a blinded trial was performed on the efficacy of different antihypertensive drugs, and an unblinded trial showed that diuretics and beta-blockers are the most effective agents when caregivers choose the agent and dose. Two healthcare models were considered: (1) the patient-friendly VA Hypertension Screening and Treatment Program that was introduced in 1972, which controls 80% of patients at the goal of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure with diuretics and keeps patients in the program an average of 7.5 years, and (2) the newer primary care health maintenance organization-like model in the VA and throughout the United States. Choosing a regimen and monitoring control of blood pressure and compliance with therapy were discussed. The meeting was closed with 6 general recommendations for improving the care of hypertensive patients.
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