Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

Ju-Yeun Lee; Ji Hoon Hong; Sangjun Lee; Seokyung An; Aesun Shin; Sue K Park

doi:10.1371/journal.pone.0270510

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

PLoS One. 2022 Jun 30;17(6):e0270510. doi: 10.1371/journal.pone.0270510. eCollection 2022.

Authors

Ju-Yeun Lee^{1

2

3}, Ji Hoon Hong^{4

5}, Sangjun Lee^{1

6

7}, Seokyung An^{1

6

7}, Aesun Shin^{1

2

6}, Sue K Park^{1

2

6}

Affiliations

¹ Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
² Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, South Korea.
³ Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea.
⁴ Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.
⁵ Department of Internal Medicine, Seoul National University Hospital, College of Medicine, Seoul, South Korea.
⁶ Cancer Research Institute, Seoul National University, Seoul, Korea.
⁷ Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea.

Abstract

Objectives: This study aimed to examine the risk of cardiovascular disease (CVD) death according to blood pressure levels and systolic and/or diastolic hypertension.

Methods: From 20,636 cohort participants, 14,375 patients were enrolled after patients with prior hypertension on antihypertensive drugs were excluded. For the combination analysis, participants were divided into four groups (systolic/diastolic hypertension, systolic hypertension only, diastolic hypertension only, and non-hypertension). The risk of CV death was calculated using the hazard ratio (HR) and 95% confidence intervals (95% CI) in a Cox regression model.

Results: The risk of CVD death increased in systolic hypertension (HR = 1.59, 95% CI 1.26-2.00) and systolic/diastolic hypertension (HR = 1.84, 95% CI 1.51-2.25). The highest risks of hemorrhagic and ischemic stroke were observed in the diastolic hypertension (HR = 4.11, 95% CI 1.40-12.06) and systolic/diastolic hypertension groups (HR = 2.59, 95% CI 1.92-3.50), respectively. The risk of CVD death was drastically increased in those with SBP≥120 mmHg/DBP≥80 mmHg. The highest risk was observed in those with SBP of 130-131 mmHg and 134-137 mmHg.

Conclusion: The combined analysis of systolic and/or diastolic hypertension appears to be a good predictor of CVD death. The risk of CVD death in the prehypertensive group could be carefully monitored as well as in the hypertensive group, presumably due to less attention and the lack of antihypertensive treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antihypertensive Agents / pharmacology
Antihypertensive Agents / therapeutic use
Blood Pressure
Cardiovascular Diseases*
Cohort Studies
Humans
Hypertension*
Systole

Substances

Antihypertensive Agents

Grants and funding

(A grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI16C1127)). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.