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Cardiac risk factors and prevention
Original research article
Longitudinal change in blood pressure is associated with cardiovascular disease mortality in a Chinese cohort
  1. Jin-Hu Fan1,
  2. Jian-Bing Wang2,
  3. Shao-Ming Wang1,
  4. Christian C Abnet3,
  5. You-Lin Qiao1,
  6. Philip R Taylor4
  1. 1 Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  2. 2 Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, China
  3. 3 Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
  4. 4 Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
  1. Correspondence to Professor You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China; qiaoy{at}cicams.ac.cn

Abstract

Background A number of studies have demonstrated a J-shaped curve between blood pressure (BP) and all-cause mortality, but few studies have used longitudinal change in BP to study mortality in the Chinese population.

Methods We performed a 30-year follow-up study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in the Linxian General Population Trial Cohort. At baseline, a total of 29 584 healthy adults were enrolled in the Linxian General Population Trial in 1985 and followed through to the end of 2014. The final analysis was restricted to 29 439 participants (55% women) after exclusion of outliers. We also examined the potential effects of BP trajectory patterns during the period of 1985–1999 on sequent risk of mortality. Adjusted Cox proportional hazards models were used to estimate HRs and 95% CIs.

Results Compared with participants with normal BP, patients with prehypertension, stage 1, stage 2 or stage 3 hypertension had an increased risk of all-cause mortality, with HRs of 1.09 (95% CI 1.05 to 1.14), 1.34 (95% CI 1.28 to 1.40), 1.69 (95% CI 1.60 to 1.79) and 2.14 (95% CI 2.01 to 2.28), respectively. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular disease and stroke mortality (total: HRs 1.22 (95% CI 1.12 to 1.34) and 1.36 (95% CI 1.23 to 1.51); cardiovascular disease: HRs 1.42 (95% CI 1.17 to 1.73) and 1.55 (95% CI 1.24 to 1.93); stroke: HRs 2.29 (95% CI 1.88 to 2.80) and 2.61 (95% CI 2.11 to 3.24), respectively).

Conclusions These findings emphasise that development of incident hypertension in middle age could increase the risk of total, cardiovascular disease and stroke mortality, and suggest that current BP targets could be revised.

Trial registration number NCT00342654;Post-results.

  • heart disease
  • epidemiology
  • stroke
  • hypertension

https://doi.org/10.1136/heartjnl-2017-312850

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    Footnotes

    • J-HF and J-BW contributed equally.

    • Contributors Y-LQ, CCA and PRT had all access to the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. J-HF, J-BW and Y-LQ contributed to study the concept and design. J-HF, J-BW and S-MW obtained and analysed the data. J-HF and J-BW drafted the report which was edited by all authors. All authors have reviewed and approved the final version.

    • Funding This work was supported by National Cancer Institute contracts (N01-SC-91030 and N01-RC-47701 to the Cancer Institute, Chinese Academy of Medical Sciences).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the Institute Review Board of US National Institutes of Health and the Chinese Academy of Medical Science.

    • Provenance and peer review Not commissioned; externally peer reviewed.