Association of Blood Pressure Trajectory With Mortality, Incident Cardiovascular Disease, and Heart Failure in the Cardiovascular Health Study.
BACKGROUND
Common blood pressure (BP) trajectories are not well established in elderly persons, and their association with clinical outcomes is uncertain.


METHODS
We used hierarchical cluster analysis to identify discrete BP trajectories among 4,067 participants in the Cardiovascular Health Study using repeated BP measures from years 0 to 7. We then evaluated associations of each BP trajectory cluster with all-cause mortality, incident cardiovascular disease (CVD, defined as stroke or myocardial infarction) (N = 2,837), and incident congestive heart failure (HF) (N = 3,633) using Cox proportional hazard models.


RESULTS
Median age was 77 years at year 7. Over a median 9.3 years of follow-up, there were 2,475 deaths, 659 CVD events, and 1,049 HF events. The cluster analysis identified 3 distinct trajectory groups. Participants in cluster 1 (N = 1,838) had increases in both systolic (SBP) and diastolic (DBP) BPs, whereas persons in cluster 2 (N = 1,109) had little change in SBP but declines in DBP. Persons in cluster 3 (N = 1,120) experienced declines in both SBP and DBP. After multivariable adjustment, clusters 2 and 3 were associated with increased mortality risk relative to cluster 1 (hazard ratio = 1.21, 95% confidence interval: 1.06-1.37 and hazard ratio = 1.20, 95% confidence interval: 1.05-1.36, respectively). Compared to cluster 1, cluster 3 had higher rates of incident CVD but associations were not statistically significant in demographic-adjusted models (hazard ratio = 1.16, 95% confidence interval: 0.96-1.39). Findings were similar when stratified by use of antihypertensive therapy.


CONCLUSIONS
Among community-dwelling elders, distinct BP trajectories were identified by integrating both SBP and DBP. These clusters were found to have differential associations with outcomes.
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California, USA.
Christopher C
CC
Smitson
Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
Rebecca
R
Scherzer
Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
Michael G
MG
Shlipak
Department of Medicine, University of Washington, Seattle, Washington, USA.
Bruce M
BM
Psaty
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
Anne B
AB
Newman
Division of Nephrology, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Mark J
MJ
Sarnak
College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.
Michelle C
MC
Odden
Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
Carmen A
CA
Peralta
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016000:Cluster Analysis; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014481:United States / Q000453:epidemiology
blood pressure; blood pressure trajectory; cardiovascular disease; elderly; hypertension; mortality.