Systolic Better Predictor of CVD than Diastolic

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Effect of age on blood pressure parameters and risk of cardiovascular

death in men.

Bowman TS, Sesso HD, Gaziano JM.

Veterans Affairs Boston Healthcare System, Massachusetts Veterans

Affairs Epidemiology, Research, and Information Center, Boston, MA,

USA. tsbowman@...

BACKGROUND: Elevated blood pressure (BP) is a risk factor for

cardiovascular disease (CVD), but it remains unclear which component-

alone or in combination-is the best predictor. We sought to determine

which BP parameters are important predictors of CVD death across a

wide age range. METHODS: We used a prospective cohort study design

with 53,163 men followed for cause-specific death during a median of

5.7 years in the Physicians' Health Study enrollment cohort. Baseline

age, systolic BP and diastolic BP were collected. We calculated

relative risks (RRs) and their 95% confidence intervals using

proportional hazard models adjusting for major risk factors for CVD,

and then stratified by age (39 to 49, 50 to 59, 60 to 69, and 70 to

84 years). RESULTS: There were 459 CVD deaths during follow-up. For

each 10 mm Hg increase in systolic BP, the multivariable RRs by

ascending age group were 1.46, 1.43, 1.24, and 1.13. The

multivariable RRs for each 10 mm Hg increase in diastolic BP were

1.25, 1.20, 1.28, and 1.07. Compared with systolic BP, pulse pressure

and mean arterial pressure were not consistent predictors across age

ranges, and combining systolic BP with another parameter did not

improve the model compared with using systolic BP alone in any age

group (all P > .05). CONCLUSIONS: In this large cohort of healthy men

with no history of hypertension, systolic BP was the most consistent

and significant predictor of CVD death across all ages. Diastolic BP

was not as strongly associated with risk. Our results support the

continuing emphasis on using systolic BP in predicting cardiovascular

risk.

PMID: 16461190 January 2006.