Development of Predictive Models for Long-Term Cardiovascular Risk Associated With Systolic and Diastolic Blood Pressure
- 1 January 2002
- journal article
- other
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 39 (1), 105-110
- https://doi.org/10.1161/hy1201.097199
Abstract
Most existing risk prediction models have not considered the joint contribution of systolic and diastolic blood pressure to cardiovascular risk, and some suggest that there are thresholds below which further reductions of blood pressure yield no additional benefit. We developed multivariate risk prediction models that quantify the risk associated with both systolic and diastolic blood pressure and that can be used to infer the benefits of antihypertensive therapy in populations. Two large clinical trial cohorts, the Physicians’ Health Study, composed of 22 071 males (mean age, 53.2 years; median follow-up, 13.0 years), and the Women’s Health Study, composed of 39 876 females (mean age, 53.8 years; median follow-up, 6.2 years), were used to develop gender-specific predictive models via Cox regression. End points included myocardial infarction, stroke, coronary artery bypass, angioplasty, and cardiovascular death. Risk reduction estimates were derived by computing reductions associated with incremental lowering of systolic and diastolic blood pressures. In both populations, lower levels of blood pressure predicted lower event rates, with no evidence of a plateau or a J-shaped curve. In males, both systolic and diastolic blood pressures were significantly associated with events ( P P <0.001) predicted outcome after multivariate adjustment. Correction for measurement error in blood pressure increased risk estimates by ≈50%. Differences in systolic blood pressure yielded greater relative risk reductions than did differences in diastolic blood pressure in a combined population of males and females. These predictive models may be useful for risk estimation associated with hypertension in similar populations and may also be used to infer the benefits of antihypertensive therapy.Keywords
This publication has 22 references indexed in Scilit:
- Estimation and Inference for Logistic Regression with Covariate Misclassification and Measurement Error in Main Study/Validation Study DesignsJournal of the American Statistical Association, 2000
- β-Carotene Supplementation and Incidence of Cancer and Cardiovascular Disease: the Women's Health StudyJNCI Journal of the National Cancer Institute, 1999
- Prevention of coronary heart disease in clinical practice Recommendations of the Second Joint Task Force of European and other Societies on Coronary PreventionEuropean Heart Journal, 1998
- Validity of physicians' self-reports of cardiovascular disease risk factorsAnnals of Epidemiology, 1993
- Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study.BMJ, 1991
- Blood pressure, stroke, and coronary heart disease *1Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution biasThe Lancet, 1990
- Final Report on the Aspirin Component of the Ongoing Physicians' Health StudyNew England Journal of Medicine, 1989
- Pulse pressure—III. Prognostic significance in four Chicago epidemiologic studiesJournal of Chronic Diseases, 1982
- RE-EXAMINATION OF SOME OF THE FRAMINGHAM BLOOD-PRESSURE DATAThe Lancet, 1978
- Systolic versus diastolic blood pressure and risk of coronary heart diseaseThe American Journal of Cardiology, 1971