title: Effect of age on blood pressure parameters and risk of cardiovascular death in men.
abstract: 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 Cox 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.
authors.affiliation: Veterans Affairs Boston Healthcare System, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, MA, USA. tsbowman@partners.org
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Bowman
authors.forename: Howard D
authors.initials: HD
authors.lastname: Sesso
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors