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Oh HJ, Lee S, Lee EK, Lee O, Ha E, Park EM, Kim SJ, Kang DH, Choi KB, Kim SJ, Ryu DR. Association of blood pressure components with mortality and cardiovascular events in prehypertensive individuals: a nationwide population-based cohort study. Ann Med 2018; 50:443-452. [PMID: 29929398 DOI: 10.1080/07853890.2018.1492146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The effects of each blood pressure index [systolic and diastolic blood pressure (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP)] on the occurrence of mortality and cardiovascular (CV) events have not yet been investigated in prehypertensive populations. METHODS A total of 30,258 prehypertensive Korean participants underwent periodic health examination between 2003 and 2004 were enrolled, and the associations of BP components with mortality and CV events were investigated. Moreover, based on the DBP [80 ≤ DBP <90 mmHg (N = 21,323) and DBP <80 mmHg (N = 8,935)], the effects of BP components were also evaluated. RESULTS Multivariate Cox analyses in prehypertensive group revealed that the hazard ratios (HRs) were 1.121 and 1.130 per 10 mmHg increase in SBP and PP for mortality, respectively. Additionally, 10 mmHg increase of SBP (HR:1.090) was still significantly, but increase of PP (HR:1.060) was marginally associated with higher incidence of CV events. However, there were no significant associations with increase in DBP or MAP on adverse clinical outcomes in prehypertensive group. In the prehypertensive subjects with DBP <80 mmHg, CV events more frequently occurred by 38.8% and 28.5% per 10 mmHg increase in SBP and PP, respectively. CONCLUSIONS Prehypertensive subjects might need to be cautioned when they have high SBP or PP with low DBP even in healthy populations. Key message Prehypertensive subjects should be cautioned when they have high-systolic blood pressure or pulse pressure with low-diastolic blood pressure, even without previous hypertension, diabetes mellitus or chronic kidney disease.
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Affiliation(s)
- Hyung Jung Oh
- a Ewha Institute of Convergence Medicine , Ewha Womans University Mokdong Hospital , Seoul , Korea.,b Research Institute for Human Health Information , Ewha Womans University Mokdong Hospital , Seoul , Korea
| | - Seulbi Lee
- c Department of Medical Science, School of Medicine , Ewha Womans University , Seoul , Korea
| | - Eun-Kyung Lee
- d Department of Statistics , Ewha Womans University , Seoul , Korea
| | - Oesook Lee
- d Department of Statistics , Ewha Womans University , Seoul , Korea
| | - Eunhee Ha
- c Department of Medical Science, School of Medicine , Ewha Womans University , Seoul , Korea.,e Department of Preventive Medicine, School of Medicine , Ewha Womans University , Seoul , Korea
| | - Eun-Mi Park
- f Department of Pharmacology , Ewha Womans University , Seoul , Republic of Korea.,g Tissue Injury Defense Research Center, College of Medicine , Ewha Womans University , Seoul , Republic of Korea
| | - Seung-Jung Kim
- h Department of Internal Medicine, School of Medicine , Ewha Womans University , Seoul , Korea
| | - Duk-Hee Kang
- h Department of Internal Medicine, School of Medicine , Ewha Womans University , Seoul , Korea
| | - Kyu Bok Choi
- h Department of Internal Medicine, School of Medicine , Ewha Womans University , Seoul , Korea
| | - Seung Jun Kim
- i Department of Internal Medicine , International St. Mary's Hospital, Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea
| | - Dong-Ryeol Ryu
- b Research Institute for Human Health Information , Ewha Womans University Mokdong Hospital , Seoul , Korea.,g Tissue Injury Defense Research Center, College of Medicine , Ewha Womans University , Seoul , Republic of Korea.,h Department of Internal Medicine, School of Medicine , Ewha Womans University , Seoul , Korea
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Shibata M, Sato KK, Uehara S, Koh H, Kinuhata S, Oue K, Kambe H, Morimoto M, Hayashi T. Blood pressure components and the risk for proteinuria in Japanese men: The Kansai Healthcare Study. J Epidemiol 2017; 27:505-510. [PMID: 28709559 PMCID: PMC5608588 DOI: 10.1016/j.je.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background We examined prospectively which of the four blood pressure (BP) components (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean arterial pressure [MAP]) was best in predicting the risk of proteinuria. Methods This prospective study included 9341 non-diabetic Japanese middle-aged men who had no proteinuria and an estimated glomerular filtration rate ≥60 mL/min/1.73 m2 and were not taking antihypertensive medications at entry. Persistent proteinuria was defined if proteinuria was detected two or more times consecutively and persistently at the annual examination until the end of follow-up. We calculated the difference in values of Akaike's information criterion (ΔAIC) in comparison of the BP components-added model to the model without them in a Cox proportional hazards model. Results During the 84,587 person-years follow-up period, we confirmed 151 cases of persistent proteinuria. In multiple-adjusted models that included a single BP component, the hazard ratios for persistent proteinuria for the highest quartile of SBP, PP, and MAP were 3.11 (95% confidence interval [CI], 1.79–5.39), 1.87 (95% CI, 1.18–2.94), and 2.21 (95% CI, 1.33–3.69) compared with the lowest quartile of SBP, PP, and MAP, respectively. The hazard ratio for the highest quartile of DBP was 2.69 (95% CI, 1.65–4.38) compared with the second quartile of DBP. Of all models that included a single BP component, those that included SBP alone or DBP alone had the highest values of ΔAIC (14.0 and 13.1, respectively) in predicting the risk of persistent proteinuria. Conclusions Of all BP components, SBP and DBP were best in predicting the risk of persistent proteinuria in middle-aged Japanese men. We examined which blood pressure (BP) components increased risk of proteinuria. We used systolic BP, diastolic BP, pulse pressure, and mean arterial pressure. Systolic and diastolic BP were the best predictors of persistent proteinuria.
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Affiliation(s)
- Mikiko Shibata
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kyoko Kogawa Sato
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Uehara
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideo Koh
- Hematology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Kinuhata
- Medical Education and General Practice, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Oue
- Kansai Health Administration Center, Nippon Telegraph and Telephone West Corporation, Osaka, Japan
| | - Hiroshi Kambe
- Kansai Health Administration Center, Nippon Telegraph and Telephone West Corporation, Osaka, Japan
| | - Michio Morimoto
- Kansai Health Administration Center, Nippon Telegraph and Telephone West Corporation, Osaka, Japan
| | - Tomoshige Hayashi
- Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan.
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