Development of Predictive Models for Long-Term Cardiovascular Risk Associated With Systolic and Diastolic Blood Pressure

Most existing risk prediction models have not considered the joint contribution of systolic and diastolic blood pressure to cardiovascular risk, and some suggest that there are thresholds below which further reductions of blood pressure yield no additional benefit. We developed multivariate risk pre...

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Bibliographic Details
Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2002-01, Vol.39 (1), p.105-110
Main Authors: Glynn, Robert J, L’Italien, Gilbert J, Sesso, Howard D, Jackson, Elizabeth A, Buring, Julie E
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antihypertensive agents
Biological and medical sciences
Blood Pressure - physiology
Cardiovascular Diseases - etiology
Cardiovascular system
Diastole - physiology
Female
Humans
Hypertension - complications
Hypertension - physiopathology
Hypertension - therapy
Male
Medical sciences
Middle Aged
Models, Cardiovascular
Pharmacology. Drug treatments
Predictive Value of Tests
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk Assessment
Sex Factors
Systole - physiology
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Summary:Most existing risk prediction models have not considered the joint contribution of systolic and diastolic blood pressure to cardiovascular risk, and some suggest that there are thresholds below which further reductions of blood pressure yield no additional benefit. We developed multivariate risk prediction models that quantify the risk associated with both systolic and diastolic blood pressure and that can be used to infer the benefits of antihypertensive therapy in populations. Two large clinical trial cohorts, the Physicians’ Health Study, composed of 22 071 males (mean age, 53.2 years; median follow-up, 13.0 years), and the Women’s Health Study, composed of 39 876 females (mean age, 53.8 years; median follow-up, 6.2 years), were used to develop gender-specific predictive models via Cox regression. End points included myocardial infarction, stroke, coronary artery bypass, angioplasty, and cardiovascular death. Risk reduction estimates were derived by computing reductions associated with incremental lowering of systolic and diastolic blood pressures. In both populations, lower levels of blood pressure predicted lower event rates, with no evidence of a plateau or a J-shaped curve. In males, both systolic and diastolic blood pressures were significantly associated with events (P
ISSN:0194-911X
1524-4563
DOI:10.1161/hy1201.097199