Ten-Year Blood Pressure Trajectories and Long-Term Risk of Cardiovascular Mortality: The Minnesota Business and Professional Men Study

S.M.A.J. Tielemans, J.M. Geleijnse, H.C. Boshuizen, S.S. Soedamah-Muthu, A. Menotti, D.R. Jacobs, H. Blackburn, D. Kromhout

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Abstract

Introduction: We characterised 10[[Unable to Display Character: ‑]]year trajectories of annual blood pressure (BP) measurements and studied the added value on long-term cardiovascular disease (CVD) mortality in comparison to a single baseline BP measurement. Methods: This study is based on data from 266 men, aged 45 to 55 years, who participated in the Minnesota Business and Professional Men Study. BP was measured annually between 1947[[Unable to Display Character: ‑]]1957, a time when only very high levels of BP were treated. Men who did not die before 1957 and did not have a history of myocardial infarction or stroke were included. We identified BP trajectories by means of finite mixture group-based trajectory modelling (PROC TRAJ in SAS). For each individual, time to death was defined as the difference in years between 1957 and year of death (the last man died in 2002). Cox proportional hazards analysis was used to examine BP trajectories in relation to CVD mortality. Results: All 266 men died and 142 (53.4%) from CVD, with mean (± sd) time to death 21±10 years. We identified four systolic BP trajectories with baseline mean systolic BP levels ranging from 112 (SBP1) to 165 (SBP4) mmHg. This difference of 53 mmHg in baseline systolic BP level was associated with a hazard ratio (HR) of 2.4 (95% CI: 1.5-3.8) for CVD mortality. From age 45 to 65, mean systolic BP levels of the four trajectories (Figure 1A) increased from 0.4 to 2.1 mmHg/year for SBP1 to SBP4. For systolic BP trajectories, the HR of CVD mortality increased from 1.6 (SBP2) to 4.2 (SBP4), compared to men in SBP1 (Figure 1A). A similar pattern was observed for diastolic BP (Figure 1B). Conclusion: In this population of middle[[Unable to Display Character: ‑]]aged US men, the increase in BP was strongest in those with the highest BP levels. Trajectories of BP predicted CVD mortality much better than a single BP measurement
Original languageEnglish
Article numberAP044
JournalCirculation
Volume129
Publication statusPublished - 2014

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