title: Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke: The Rotterdam Study.
abstract: Hypertension is a major modifiable risk factor for stroke. Associations of blood pressure with incident stroke are mostly based on single or average blood pressure levels. However, this approach does not take into account long-term trajectories of blood pressure, which can vary considerably in the elderly. Within the population-based Rotterdam Study, we examined trajectories of systolic blood pressure in 6745 participants (60.0% women) over an age-range from 55 to 106 years and jointly modeled their risk of stroke and competing causes of death using joint latent class mixed modeling. Four trajectories were identified. Class 1 was characterized by blood pressure increasing gradually from on average 120 to 160 mm Hg over 5 decades (n=4938). Compared with this class, class 2, characterized by a similar midlife blood pressure, but a steep increase (n=822, increasing from 120 to 200 mm Hg), and class 4, characterized by a high midlife blood pressure (n=115; average 160 mm Hg) and had a higher risk of stroke and death. Class 3, characterized by a moderate midlife blood pressure (n=870; average 140 mm Hg), had a similar risk of death as class 1, but the highest risk of stroke. Assessing trajectories of blood pressure provides a more nuanced understanding of the associations between blood pressure, stroke, and mortality. In particular, high blood pressure and rapidly increasing blood pressure patterns are associated with a high risk of stroke and death, whereas moderately high blood pressure is only related to an increased risk of stroke. Future studies should explore the potential pathogenic significance of these patterns.
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Saira Saeed
authors.initials: SS
authors.lastname: Mirza
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Vincentius J A
authors.initials: VJ
authors.lastname: Verlinden
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
authors.forename: Sonja A
authors.initials: SA
authors.lastname: Swanson
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., S.S.M., V.J.A.V., A.H., S.A.S., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.). m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D009426:Netherlands; D011153:Population; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; epidemiology; hypertension; mortality; stroke