Sang-Wook Yi1, Yejin Mok1, Heechoul Ohrr1, Jee-Jeon Yi1, Young Duk Yun1, Jihwan Park1, Sun Ha Jee2. 1. From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.). 2. From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.). jsunha@yuhs.ac.
Abstract
BACKGROUND: The association between low systolic blood pressure (SBP) and vascular disease is unclear, especially in nonclinical populations. METHODS AND RESULTS: We studied 1 235 246 individuals who participated in routine medical examinations between 1992 and 1995. The hazard ratios (HRs) were adjusted for potential confounders. During 22.7 million person-years of follow-up, 34 816 individuals died of atherosclerotic vascular diseases. An increase in SBP was directly related to an increase in vascular mortality at SBP above ≈100 mmHg. The group with the lowest SBP (<90 mm Hg) had a higher HR for mortality from atherosclerotic vascular disease (HR, 1.53; 95% confidence interval, 1.15-2.03) in comparison with those with an SBP of 90 to 99 mm Hg. The HR associated with the lowest SBP was 2.54 (95% confidence interval, 1.51-4.29) for ischemic heart disease and 1.21 (95% confidence interval, 0.79-1.85) for stroke. Regarding stroke subtype, mortality from hemorrhagic stroke (HR per 10 mm Hg increase, 0.53; 95% confidence interval, 0.29-0.96), rather than mortality from ischemic stroke (HR per 10 mm Hg increase, 1.00; 95% confidence interval, 0.51-1.97), was inversely associated with SBP when SBP fell to <100 mm Hg. Even when excluding the first 5 years of follow-up, the HRs associated with the lowest SBP did not decrease. The inverse association between SBP and vascular mortality in the range <100 mm Hg tended to be apparent in people aged 60 to 95 years in comparison with individuals aged 30 to 59 years. CONCLUSIONS: J-curve associations exist between SBP and vascular mortality, which reach a nadir at ≈100 mm Hg. SBP of <90 mm Hg may portend death from vascular disease, particularly from ischemic heart disease.
BACKGROUND: The association between low systolic blood pressure (SBP) and vascular disease is unclear, especially in nonclinical populations. METHODS AND RESULTS: We studied 1 235 246 individuals who participated in routine medical examinations between 1992 and 1995. The hazard ratios (HRs) were adjusted for potential confounders. During 22.7 million person-years of follow-up, 34 816 individuals died of atherosclerotic vascular diseases. An increase in SBP was directly related to an increase in vascular mortality at SBP above ≈100 mmHg. The group with the lowest SBP (<90 mm Hg) had a higher HR for mortality from atherosclerotic vascular disease (HR, 1.53; 95% confidence interval, 1.15-2.03) in comparison with those with an SBP of 90 to 99 mm Hg. The HR associated with the lowest SBP was 2.54 (95% confidence interval, 1.51-4.29) for ischemic heart disease and 1.21 (95% confidence interval, 0.79-1.85) for stroke. Regarding stroke subtype, mortality from hemorrhagic stroke (HR per 10 mm Hg increase, 0.53; 95% confidence interval, 0.29-0.96), rather than mortality from ischemic stroke (HR per 10 mm Hg increase, 1.00; 95% confidence interval, 0.51-1.97), was inversely associated with SBP when SBP fell to <100 mm Hg. Even when excluding the first 5 years of follow-up, the HRs associated with the lowest SBP did not decrease. The inverse association between SBP and vascular mortality in the range <100 mm Hg tended to be apparent in people aged 60 to 95 years in comparison with individuals aged 30 to 59 years. CONCLUSIONS: J-curve associations exist between SBP and vascular mortality, which reach a nadir at ≈100 mm Hg. SBP of <90 mm Hg may portend death from vascular disease, particularly from ischemic heart disease.
Authors: Jin-Hu Fan; Jian-Bing Wang; Shao-Ming Wang; Christian C Abnet; You-Lin Qiao; Philip R Taylor Journal: Heart Date: 2018-04-24 Impact factor: 5.994