title: Mean arterial pressure is better at predicting future metabolic syndrome in the normotensive elderly: a prospective cohort study in Taiwan.
abstract: OBJECTIVE
  To compare four different blood pressure (BP) measurements-systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP)-in predicting future metabolic syndrome (MetS) among the normotensive elderly population, and to estimate the optimal cutoff value of the best single measurement for clinical practice.
  
  
  METHODS
  A total of 2782 non-medicated participants aged ≥ 60 years were enrolled in a standard health examination program in Taiwan from January 2004 to December 2013. Two thirds of the participants were randomly designated as the training group (n=1855) and the other one third as the validation group (n=927). The mean follow-up time was 3.60 years for both the training and validation groups. MAP and PP were calculated from SBP and DBP.
  
  
  RESULTS
  SBP, DBP, and MAP were associated with future MetS, whereas PP was not. MAP had the largest hazard ratio in Cox regression (men 1.342 [95% CI 1.158-1.555] and women 1.348 [95% CI 1.185-1.534] in the training group; men 1.640 [95% CI 1.317-2.041] and women 1.485 [95% CI 1.230-1.794] in the validation group) and the largest area under the receiver operating characteristic curve (men 0.598 ± 0.021 and women 0.602 ± 0.021 in the training group). Multivariable Cox regression further indicated that a higher MAP level was independently associated with the future occurrence of MetS. Participants with MAP above the cutoff value (84.0mm Hg for men, 83.3mm Hg for women) had a higher cumulative incidence of MetS than did their counterparts after four years' follow-up in both the training and validation groups. The results derived from the training data could be replicated in the validation data, indicating that the results were generalizable across distinct samples.
  
  
  CONCLUSIONS
  MAP is more accurate than SBP, DBP, and PP in predicting future MetS among the normotensive geriatric population. Calculation of MAP is recommended when dealing with normotensive patients aged ≥ 60 years in clinical practice.
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Chun-Hsien
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Pathology, National Defense Medical Center, Division of Clinical Pathology, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Jin-Biou
authors.initials: JB
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, ShuangHo Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: I-Chao
authors.initials: IC
authors.lastname: Liu
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Shu Chuen
authors.initials: SC
authors.lastname: Lau
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Shu-Man
authors.initials: SM
authors.lastname: Yu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chang-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, ShuangHo Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jiunn-Diann
authors.initials: JD
authors.lastname: Lin
authors.affiliation: Department of Life Science, Institute of Applied Science and Engineering, College of Science and Engineering, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Yao-Jen
authors.initials: YJ
authors.lastname: Liang
authors.affiliation: Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Dee
authors.initials: D
authors.lastname: Pei
authors.affiliation: Department of Pathology, Cardinal Tien Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan. Electronic address: anthonypatho@gmail.com.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve
keywords: Elderly; Mean arterial pressure; Metabolic syndrome; Preventive geriatrics; Primary prevention