eprintid: 1431745
rev_number: 73
eprint_status: archive
userid: 608
dir: disk0/01/43/17/45
datestamp: 2014-06-09 18:48:06
lastmod: 2021-11-30 23:07:08
status_changed: 2017-12-20 16:43:43
type: article
metadata_visibility: show
item_issues_count: 0
creators_name: Rapsomaniki, E
creators_name: Timmis, A
creators_name: George, J
creators_name: Pujades-Rodriguez, M
creators_name: Shah, AD
creators_name: Denaxas, S
creators_name: White, IR
creators_name: Caulfield, MJ
creators_name: Deanfield, JE
creators_name: Smeeth, L
creators_name: Williams, B
creators_name: Hingorani, A
creators_name: Hemingway, H
title: Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people
ispublished: pub
divisions: UCL
divisions: B02
divisions: D65
divisions: D14
divisions: GA4
divisions: GA3
divisions: DD4
divisions: J73
keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, PERIPHERAL ARTERIAL-DISEASE, ABDOMINAL AORTIC-ANEURYSMS, PRACTICE RESEARCH DATABASE, RANDOMIZED-TRIALS, METAANALYSIS, EVENTS, PREVALENCE, PREVENTION, MORTALITY, STROKE
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abstract: Background

The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease.

Methods

We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371.

Findings

During 5·2 years median follow-up, we recorded 83 098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32–1·58]), subarachnoid haemorrhage (1·43 [1·25–1·63]), and stable angina (1·41 [1·36–1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00–1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86–0·98]) and strongest for peripheral arterial disease (1·23 [1·20–1·27]). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9–63·8) compared with 46·1% (45·5–46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8–5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years.

Interpretation

The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them.

Funding

Medical Research Council, National Institute for Health Research, and Wellcome Trust.
date: 2014-05-31
date_type: published
publisher: ELSEVIER SCIENCE INC
official_url: https://doi.org/10.1016/S0140-6736(14)60685-1
vfaculties: VFPHS
vfaculties: VFPHS
vfaculties: VFPHS
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
article_type_text: Article
verified: verified_manual
elements_source: PubMed
elements_id: 950458
doi: 10.1016/S0140-6736(14)60685-1
lyricists_name: Deanfield, John
lyricists_name: Denaxas, Spyridon
lyricists_name: George, Julie
lyricists_name: Hemingway, Harry
lyricists_name: Hingorani, Aroon
lyricists_name: Pujades Rodriguez, Maria
lyricists_name: Rapsomaniki, Eleni
lyricists_name: Shah, Anoop
lyricists_name: White, Ian
lyricists_name: Williams, Bryan
lyricists_id: JDEAN52
lyricists_id: SDENA57
lyricists_id: JGEOR67
lyricists_id: HHEMI65
lyricists_id: AHING65
lyricists_id: MDMPU72
lyricists_id: ERAPS76
lyricists_id: ASHAH69
lyricists_id: IWWHI35
lyricists_id: BWILL10
actors_name: Stacey, Thomas
actors_id: TSSTA20
actors_role: owner
full_text_status: public
publication: Lancet
volume: 383
number: 9932
pagerange: 1899-1911
pages: 13
issn: 1474-547X
citation:        Rapsomaniki, E;    Timmis, A;    George, J;    Pujades-Rodriguez, M;    Shah, AD;    Denaxas, S;    White, IR;                         ... Hemingway, H; + view all <#>        Rapsomaniki, E;  Timmis, A;  George, J;  Pujades-Rodriguez, M;  Shah, AD;  Denaxas, S;  White, IR;  Caulfield, MJ;  Deanfield, JE;  Smeeth, L;  Williams, B;  Hingorani, A;  Hemingway, H;   - view fewer <#>    (2014)    Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people.                   Lancet , 383  (9932)   pp. 1899-1911.    10.1016/S0140-6736(14)60685-1 <https://doi.org/10.1016/S0140-6736%2814%2960685-1>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/1431745/1/Deanfield_1-s2.0-S0140673614606851-main.pdf