Blood Pressure and Incidence of Twelve Cardiovascular Diseases: Lifetime Risks, Healthy Life-Years Lost, and Age-Specific Associations in 1.25 Million People

Study Questions:

What are associations of hypertension with 12 different forms of cardiovascular disease across different age groups?

Methods:

This was a retrospective analysis of 1.25 million patients with linked electronic health records from 1997 to 2010, in the CALIBER (Cardiovascular research using Linked Bespoke studies and Electronic health Records) program. Eligible patients were 30 years of age or older and initially free from cardiovascular disease. Endpoints were the initial presentation of cardiovascular disease as any of 12 acute and chronic cardiovascular diseases (stable angina, unstable angina, myocardial infarction, unheralded coronary heart disease death, heart failure, cardiac arrest/sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, peripheral arterial disease, and abdominal aortic aneurysm). The authors also estimated the lifetime risks and cardiovascular disease-free life-years lost adjusted for other risk factors at ages 30, 60, and 80 years.

Results:

Median follow-up was 5.2 years. The lowest risk for cardiovascular disease was in those with systolic blood pressure of 90-114 mm Hg and diastolic blood pressure of 60-74 mm Hg across all age groups. The lifetime risk of total cardiovascular disease at 30 years of age was 63.3% (95% confidence interval [CI], 62.9-63.8) in those with hypertension and 46.1% (95% CI, 45.5-46.8) in those without hypertension. The mean number of cardiovascular disease-free life-years lost associated with hypertension was 5.0 years (95% CI, 4.8-5.4) from 30 years of age, 3.4 years (95% CI, 3.3-3.6) from 60 years, and 1.6 years (1.5-1.7) from 80 years. High systolic blood pressure had the strongest associations with intracerebral hemorrhage (hazard ratio [HR], 1.44; 95% CI, 1.32-1.58), subarachnoid hemorrhage (HR, 1.43; 95% CI, 1.25-1.63), and stable angina (HR, 1.41; 95% CI, 1.36-1.46). Diastolic blood pressure had a greater association with abdominal aortic aneurysm, compared to systolic blood pressure.

Conclusions:

There is significant heterogeneity in associations between systolic and diastolic blood pressure across a range of acute and chronic cardiovascular diseases, and at various ages.

Perspective:

With hypertension contributing to over 9 million deaths worldwide yearly, there is an imperative to better understand the associations of hypertension with different forms of cardiovascular disease. The present study is a major step forward in establishing the burden of hypertension across a range of acute and chronic cardiovascular diseases and age groups. The authors also demonstrate that the impact of systolic and diastolic blood pressures is not always concordant. Most importantly, the authors draw attention to the need for focus on blood pressure as a reversible risk factor. The reported lifetime risk conferred by hypertension is a call to action for the aggressive treatment of hypertension at all ages, including the elderly. The present study may also suggest the need for more aggressive treatment of “milder” forms of hypertension.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Acute Heart Failure, Hypertension, Chronic Angina

Keywords: Subarachnoid Hemorrhage, Myocardial Infarction, Stroke, Ischemic Attack, Transient, Follow-Up Studies, Angina, Stable, Coronary Disease, Peripheral Arterial Disease, Blood Pressure, Risk Factors, Cost of Illness, Systole, Heart Failure, Confidence Intervals, Aortic Aneurysm, Abdominal, Hypertension, Death, Sudden, Cardiac, Cerebral Hemorrhage


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