title: Do other cardiovascular risk factors influence the impact of age on the association between blood pressure and mortality? The MORGAM Project.
abstract: OBJECTIVE
  To investigate age-related shifts in the relative importance of SBP and DBP as predictors of cardiovascular mortality and all-cause mortality and whether these relations are influenced by other cardiovascular risk factors.
  
  
  METHODS
  Using 42 cohorts from the MORGAM Project with baseline between 1982 and 1997, 85 772 apparently healthy Europeans and Australians aged 19-78 years were included. During 13.3 years of follow-up, 9.2% died (of whom 7.2% died due to stroke and 21.1% due to coronary heart disease, CHD).
  
  
  RESULTS
  Mortality risk was analyzed using hazard ratios per 10-mmHg/5-mmHg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, SBP and DBP were analyzed separately for blood pressure (BP) values above and below a cut-point wherein mortality risk was the lowest. For the total population, significantly positive associations were found between stroke mortality and SBP [hazard ratio = 1.19 (1.13-1.25)] and DBP at least 78 mmHg [hazard ratio = 1.08 (1.02-1.14)], CHD mortality and SBP at least 116 mmHg [1.20 (1.16-1.24)], and all-cause mortality and SBP at least 120 mmHg [1.09 (1.08-1.11)] and DBP at least 82 mmHg [1.03 (1.02-1.05)]. BP values below the cut-points were inversely related to mortality risk. Taking into account the age × BP interaction, there was a gradual shift from DBP (19-26 years) to both DBP and SBP (27-62 years) and to SBP (63-78 years) as risk factors for stroke mortality and all-cause mortality, but not CHD mortality. The age at which the importance of SBP exceeded DBP was for stroke mortality influenced by sex, cholesterol, and country risk.
  
  
  CONCLUSIONS
  Age-related shifts to the superiority of SBP exist for stroke mortality and all-cause mortality, and for stroke mortality was this shift influenced by other cardiovascular risk factors.
authors.affiliation: aCardiovascular Department of Internal Medicine, Cardiovascular Research Unit bResearch Centre for Prevention and Health, Glostrup University Hospital, Glostrup cDivision of Cardiology, Holbaek University Hospital, Holbaek, Denmark dDepartment of Cardiovascular Epidemiology and Prevention, the Cardinal Stefan Wyszynski, Institute of Cardiology, Warsaw, Poland eCerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology, Surveillance, and Promotion of Health, National Institute of Health, Rome, Italy fUKCRC Centre of Excellence for Public Health Research (NI), the Queen's University of Belfast, Belfast, Northern Ireland, UK gClinica Medica e Istituto Auxologico Italiano, Milan hResearch Centre on Chronic Degenerative Diseases (Osp. S. Gerardo), Monza, Italy iNational Institute for Health and Welfare (THL), Helsinki, Finland jDepartment of Health, Institute of Health Studies, Barcelona, Spain kDepartment of Cardiology, Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France lInstitute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania mDepartment of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden nSchool of Medicine and Public Health, University of Newcastle, New Castle, New South Wales, Australia oFaculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France pDepartment of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University of Medical College, Krakow, Poland qDepartment of Endocrinology, The Cardiovascular and Metabolic Preventive Clinic, Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark rHypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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authors.initials: JK
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mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult