title: Systolic blood pressure and cardiovascular mortality in middle-aged and elderly adults - The Singapore Chinese Health Study.
abstract: BACKGROUND
  While elevated systolic blood pressure (SBP) is related to cardiovascular disease (CVD) mortality, it is unclear if the optimal SBP level may differ by age or the presence of underlying CVD.
  
  
  OBJECTIVE
  We investigated the association between SBP categories and CVD mortality among middle-aged and elderly adults with and without CVD history.
  
  
  METHODS
  We used data from 30,692 participants of the population-based Singapore Chinese Health Study who had blood pressures measured using a standard protocol at ages 48-85years between 1994 and 2005. Information on lifestyle factors were collected at recruitment (1993-1998) and during follow-up interviews (1999 and 2004). Mortality was identified via nationwide registry linkage up to 31 December 2014.
  
  
  RESULTS
  SBP 120-139mmHg category was associated with lowest risk of CVD mortality in both age-groups of <60 and 60+years, as well as in those with and without underlying coronary heart disease or stroke. Overall, compared to this category, CVD risk was non-significantly increased in lower SBP categories and significantly increased in the higher SBP categories. The risk estimates associated with elevated SBP were higher among those <60years compared to their older counterparts, but less distinct between those with and without underlying CVD.
  
  
  CONCLUSIONS
  SBP 120-139mmHg was associated with the lowest risk of CVD mortality in middle aged and elderly adults, regardless of underlying CVD. Although risks in both adult groups were similar, there is a greater risk associated with higher SBP among those aged below 60years, highlighting a greater urgency of treatment in this younger group.
authors.affiliation: National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Koh
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Talaei
authors.affiliation: Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
keywords: Blood pressure; Cardiovascular disease; Epidemiology; Hypertension; Mortality; Systolic