title: Low Systolic Blood Pressure and Vascular Mortality Among More Than 1 Million Korean Adults.
abstract: The association between low systolic blood pressure (SBP) and vascular disease is unclear, especially in nonclinical populations.
  
  
  
  We studied 1 235 246 individuals who participated in routine medical examinations between 1992 and 1995. The hazard ratios (HRs) were adjusted for potential confounders. During 22.7 million person-years of follow-up, 34 816 individuals died of atherosclerotic vascular diseases. An increase in SBP was directly related to an increase in vascular mortality at SBP above ≈100 mmHg. The group with the lowest SBP (<90 mm Hg) had a higher HR for mortality from atherosclerotic vascular disease (HR, 1.53; 95% confidence interval, 1.15-2.03) in comparison with those with an SBP of 90 to 99 mm Hg. The HR associated with the lowest SBP was 2.54 (95% confidence interval, 1.51-4.29) for ischemic heart disease and 1.21 (95% confidence interval, 0.79-1.85) for stroke. Regarding stroke subtype, mortality from hemorrhagic stroke (HR per 10 mm Hg increase, 0.53; 95% confidence interval, 0.29-0.96), rather than mortality from ischemic stroke (HR per 10 mm Hg increase, 1.00; 95% confidence interval, 0.51-1.97), was inversely associated with SBP when SBP fell to <100 mm Hg. Even when excluding the first 5 years of follow-up, the HRs associated with the lowest SBP did not decrease. The inverse association between SBP and vascular mortality in the range <100 mm Hg tended to be apparent in people aged 60 to 95 years in comparison with individuals aged 30 to 59 years.
  
  
  
  J-curve associations exist between SBP and vascular mortality, which reach a nadir at ≈100 mm Hg. SBP of <90 mm Hg may portend death from vascular disease, particularly from ischemic heart disease.
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Yi
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Yejin
authors.initials: Y
authors.lastname: Mok
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Heechoul
authors.initials: H
authors.lastname: Ohrr
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Jee-Jeon
authors.initials: JJ
authors.lastname: Yi
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Young Duk
authors.initials: YD
authors.lastname: Yun
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.).
authors.forename: Jihwan
authors.initials: J
authors.lastname: Park
authors.affiliation: From Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Institute for Clinical and Translational Research, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea (S.-W.Y,); Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (Y.M., S.H.J.); Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.O.); Institute for Occupational and Environmental Health, Catholic Kwandong University, Republic of Korea (J.-J.Y.); National Health Insurance Service, Wonju, Republic of Korea (Y.D.Y.); and Department of Applied Statistics, Graduate School, Yonsei University, Seoul, Republic of Korea (J.P.). jsunha@yuhs.ac.
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Jee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D013599:Systole; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality* / Q000503:physiopathology
keywords: blood pressure; cohort studies; hypotension; mortality; vascular diseases