title: Blood pressure and cardiovascular morbidity and mortality in a Dutch population: the Nijmegen cohort study.
abstract: BACKGROUND
  The objective was to determine the influence of systolic blood pressure and diastolic blood pressure on the development of coronary heart disease over an 18-year period in a Dutch general practice population.
  
  
  METHODS
  The Nijmegen Cohort Study is a prospective cohort study with an 18-year follow-up. In 1977 systolic blood pressure, diastolic blood pressure, and other cardiovascular risk factors were measured in 7,092 Caucasians, men and women. The screening took place in six general practices, participating in a university registration network. Cardiovascular disease and all mortality was registrated during the 1977-1995 period. A Cox proportional hazard model was performed separately for men and women with the first onset of a coronary heart disease as the outcome variable. Age, smoking, serum cholesterol, blood pressure, and socioeconomic class were included as independent variables.
  
  
  RESULTS
  During the 18-year follow-up period, 205 men and 63 women suffered a nonfatal myocardial infarction. During this time, 205 deaths were identified, of which 54 were cardiovascular. Of all deaths, 139 were noncardiovascular, of which 10% were due to accident or suicide, while in 12 participants the cause of death was uncertain. The analysis indicated that both the systolic and the diastolic blood pressure were independently associated with the likelihood for developing coronary heart disease, as were the other risk factors. For coronary heart disease, the significant risk ratios for the systolic blood pressure were 1.6 for men and 2.1 for women. For the diastolic blood pressure a risk ratio was found of 1.4 for men and 2.0 for women.
  
  
  CONCLUSIONS
  A significant relation between blood pressure and coronary heart disease was demonstrated. As mean blood pressures, cholesterol levels, smoking habits, and socioeconomic class in this cohort did not differ from other figures in The Netherlands, extrapolation of the results to the Dutch population is possible.
authors.affiliation: Department of General Practice, University of Nijmegen, 229 HSV, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. K.Bakx@ksv.kun.nl
authors.forename: J C
authors.initials: JC
authors.lastname: Bakx
authors.forename: M I
authors.initials: MI
authors.lastname: Veldstra
authors.forename: H M
authors.initials: HM
authors.lastname: van den Hoogen
authors.forename: G A
authors.initials: GA
authors.lastname: Zielhuis
authors.forename: T
authors.initials: T
authors.lastname: Thien
authors.forename: C
authors.initials: C
authors.lastname: van Weel
authors.forename: W M
authors.initials: WM
authors.lastname: van den Bosch
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D017678:Sex Distribution