Average blood pressure and cardiovascular disease-related mortality in middle-aged women.
BACKGROUND
The aim of this study was to assess which average blood pressure (BP) component (ie, systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], or mean arterial pressure [MAP]), is most strongly related to cardiovascular disease (CVD)-related mortality and to evaluate whether the strength of the relation varies with follow-up time.


METHODS
This was a prospective cohort study. The studied cohort comprised a population of postmenopausal women (n = 7813) between the ages of 49 and 66 years of age, of whom four BP measurements were available, obtained at four different time points. Average BP, ie, the mean of the four measurements divided by the standard deviation, was entered in Cox proportional hazards models to facilitate direct comparison. Hazard ratios (HR) were calculated adjusted for age, body mass index, presence of diabetes mellitus, smoking habit, and use of BP-lowering medication. In addition analyses were repeated in strata of follow-up time (10, 15, and 20 years).


RESULTS
During a mean follow-up of 13.1 years, 463 CVD-related deaths occurred. For SBP and MAP the highest HR for CVD mortality were found; however, the confidence intervals (CI) overlapped (SBP: HR = 1.43, 95% CI = 1.30 to 1.58; DBP: HR = 1.35, 95% CI = 1.23 to 1.50; PP: HR = 1.30, 95% CI = 1.19 to 1.42; MAP: HR = 1.43, 95% CI = 1.30 to 1.58). Analyses in strata of follow-up time did not show a difference in strength of the associations with increasing follow-up time.


CONCLUSIONS
In this prospective follow-up study of postmenopausal women, SBP and MAP seemed to be strongest related with CVD-related death; however the CI of the HR overlapped.
van Trijp
Marijke J C A
MJ
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Grobbee
Diederick E
DE
Peeters
Petra H M
PH
van Der Schouw
Yvonne T
YT
Bots
Michiel L
ML
D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D013599:Systole; D013997:Time Factors