title: Blood pressure and mortality: using offspring blood pressure as an instrument for own blood pressure in the HUNT study.
abstract: Given that observational associations may be inaccurate, we used offspring blood pressure (BP) to provide alternative estimates of the associations between own BP and mortality. Observational associations between BP and mortality, estimated as hazard ratios (HRs) from Cox regression, were compared to HRs obtained using offspring BP as an instrumental variable (IV) for own BP (N = 32,227 mother-offspring and 27,535 father-offspring pairs). Observationally, there were positive associations between own BP and mortality from all-causes, cardiovascular disease (CVD), coronary heart disease (CHD), stroke and diabetes. Point estimates of the associations between BP and mortality from all-causes, CVD and CHD were amplified in magnitude when using offspring BP as an IV. For example, the HR for all-cause mortality per standard deviation (SD) increase in own systolic BP (SBP) obtained in conventional observational analyses increased from 1.10 (95% CI: 1.09-1.12; P < 0.0001) to 1.31 (95% CI: 1.19-1.43; P < 0.0001). Additionally, SBP was positively associated with diabetes and cancer mortality (HRs: 2.00; 95% CI: 1.12-3.35; P = 0.02 and 1.20; 95% CI: 1.02-1.42; P = 0.03, respectively), and diastolic BP (DBP) with stroke mortality (HR: 1.30; 95% CI: 1.02-1.66; P = 0.03). Results support positive associations between BP and mortality from all-causes, CVD, and CHD, SBP on cancer mortality, and DBP on stroke mortality.
authors.affiliation: 1] MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol UK [2] School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: Kaitlin H
authors.initials: KH
authors.lastname: Wade
authors.affiliation: 1] MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol UK [2] School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: David
authors.initials: D
authors.lastname: Carslake
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
authors.forename: Tom Ivar
authors.initials: TI
authors.lastname: Nilsen
authors.affiliation: 1] MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol UK [2] School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Timpson
authors.affiliation: 1] MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol UK [2] School of Social and Community Medicine, University of Bristol, Bristol UK.
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Romundstad
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000503:physiopathology