Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project

Julie K K Vishram; Anders Borglykke; Anne H Andreasen; Jørgen Jeppesen; Hans Ibsen; Torben Jørgensen; Grazyna Broda; Luigi Palmieri; Simona Giampaoli; Chiara Donfrancesco; Frank Kee; Giuseppe Mancia; Giancarlo Cesana; Kari Kuulasmaa; Susana Sans; Michael H Olsen; On behalf of the MORGAM Project

doi:10.1161/HYPERTENSIONAHA.112.201400

Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project

Julie K K Vishram, Anders Borglykke, Anne H Andreasen, Jørgen Jeppesen, Hans Ibsen, Torben Jørgensen, Grazyna Broda, Luigi Palmieri, Simona Giampaoli, Chiara Donfrancesco, Frank Kee, Giuseppe Mancia, Giancarlo Cesana, Kari Kuulasmaa, Susana Sans, Michael H Olsen, On behalf of the MORGAM Project

Department of Public Health

61 Citations (Scopus)

Abstract

This study investigates age-related shifts in the relative importance of systolic (SBP) and diastolic (DBP) blood pressures as predictors of stroke and whether these relations are influenced by other cardiovascular risk factors. Using 34 European cohorts from the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project with baseline between 1982 and 1997, 68 551 subjects aged 19 to 78 years, without cardiovascular disease and not receiving antihypertensive treatment, were included. During a mean of 13.2 years of follow-up, stroke incidence was 2.8%. Stroke risk was analyzed using hazard ratios per 10-mm Hg/5-mm Hg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, DBP was analyzed separately for DBP <71 mm Hg and DBP <71 mm Hg. Stroke risk was associated positively with SBP and DBP <71 mm Hg (SBP/DBP <71 mm Hg; hazard ratios: 1.15/1.06 [95% CI: 1.12-1.18/1.03-1.09]) and negatively with DBP <71 mm Hg (0.88[0.79-0.98]). The hazard ratio for DBP decreased with age (P<0.001) and was not influenced by other cardiovascular risk factors. Taking into account the age×DBP interaction, both SBP and DBP <71 mm Hg were significantly associated with stroke risk until age 62 years, but in subjects older than 46 years the superiority of SBP for stroke risk exceeded that of DBP <71 mm Hg and remained significant until age 78 years. DBP <71 mm Hg became significant at age 50 years with an inverse relation to stroke risk. In Europeans, stroke risk should be assessed by both SBP and DBP until age 62 years with increased focus on SBP from age 47 years. From age 62 years, emphasis should be on SBP without neglecting the potential harm of very low DBP.

Original language	English
Journal	Hypertension
Volume	60
Issue number	5
Pages (from-to)	1117-1123
Number of pages	7
ISSN	0194-911X
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.112.201400
Publication status	Published - Nov 2012

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Vishram, J. K. K., Borglykke, A., Andreasen, A. H., Jeppesen, J., Ibsen, H., Jørgensen, T., Broda, G., Palmieri, L., Giampaoli, S., Donfrancesco, C., Kee, F., Mancia, G., Cesana, G., Kuulasmaa, K., Sans, S., Olsen, M. H., & On behalf of the MORGAM Project (2012). Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. Hypertension, 60(5), 1117-1123. https://doi.org/10.1161/HYPERTENSIONAHA.112.201400

Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk : The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. / Vishram, Julie K K; Borglykke, Anders; Andreasen, Anne H et al.

In: Hypertension, Vol. 60, No. 5, 11.2012, p. 1117-1123.

Research output: Contribution to journal › Journal article › Research › peer-review

Vishram, JKK, Borglykke, A, Andreasen, AH, Jeppesen, J, Ibsen, H, Jørgensen, T, Broda, G, Palmieri, L, Giampaoli, S, Donfrancesco, C, Kee, F, Mancia, G, Cesana, G, Kuulasmaa, K, Sans, S, Olsen, MH & On behalf of the MORGAM Project 2012, 'Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project', Hypertension, vol. 60, no. 5, pp. 1117-1123. https://doi.org/10.1161/HYPERTENSIONAHA.112.201400

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title = "Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project",

abstract = "This study investigates age-related shifts in the relative importance of systolic (SBP) and diastolic (DBP) blood pressures as predictors of stroke and whether these relations are influenced by other cardiovascular risk factors. Using 34 European cohorts from the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project with baseline between 1982 and 1997, 68 551 subjects aged 19 to 78 years, without cardiovascular disease and not receiving antihypertensive treatment, were included. During a mean of 13.2 years of follow-up, stroke incidence was 2.8%. Stroke risk was analyzed using hazard ratios per 10-mm Hg/5-mm Hg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, DBP was analyzed separately for DBP <71 mm Hg and DBP <71 mm Hg. Stroke risk was associated positively with SBP and DBP <71 mm Hg (SBP/DBP <71 mm Hg; hazard ratios: 1.15/1.06 [95% CI: 1.12-1.18/1.03-1.09]) and negatively with DBP <71 mm Hg (0.88[0.79-0.98]). The hazard ratio for DBP decreased with age (P<0.001) and was not influenced by other cardiovascular risk factors. Taking into account the age×DBP interaction, both SBP and DBP <71 mm Hg were significantly associated with stroke risk until age 62 years, but in subjects older than 46 years the superiority of SBP for stroke risk exceeded that of DBP <71 mm Hg and remained significant until age 78 years. DBP <71 mm Hg became significant at age 50 years with an inverse relation to stroke risk. In Europeans, stroke risk should be assessed by both SBP and DBP until age 62 years with increased focus on SBP from age 47 years. From age 62 years, emphasis should be on SBP without neglecting the potential harm of very low DBP.",

author = "Vishram, {Julie K K} and Anders Borglykke and Andreasen, {Anne H} and J{\o}rgen Jeppesen and Hans Ibsen and Torben J{\o}rgensen and Grazyna Broda and Luigi Palmieri and Simona Giampaoli and Chiara Donfrancesco and Frank Kee and Giuseppe Mancia and Giancarlo Cesana and Kari Kuulasmaa and Susana Sans and Olsen, {Michael H} and Olsen, {Michael Hecht}",

year = "2012",

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doi = "10.1161/HYPERTENSIONAHA.112.201400",

language = "English",

volume = "60",

pages = "1117--1123",

journal = "Hypertension",

issn = "0194-911X",

publisher = "Lippincott Williams & Wilkins",

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T1 - Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk

T2 - The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project

AU - Vishram, Julie K K

AU - Borglykke, Anders

AU - Andreasen, Anne H

AU - Jeppesen, Jørgen

AU - Ibsen, Hans

AU - Jørgensen, Torben

AU - Broda, Grazyna

AU - Palmieri, Luigi

AU - Giampaoli, Simona

AU - Donfrancesco, Chiara

AU - Kee, Frank

AU - Mancia, Giuseppe

AU - Cesana, Giancarlo

AU - Kuulasmaa, Kari

AU - Sans, Susana

AU - Olsen, Michael H

AU - On behalf of the MORGAM Project

PY - 2012/11

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N2 - This study investigates age-related shifts in the relative importance of systolic (SBP) and diastolic (DBP) blood pressures as predictors of stroke and whether these relations are influenced by other cardiovascular risk factors. Using 34 European cohorts from the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project with baseline between 1982 and 1997, 68 551 subjects aged 19 to 78 years, without cardiovascular disease and not receiving antihypertensive treatment, were included. During a mean of 13.2 years of follow-up, stroke incidence was 2.8%. Stroke risk was analyzed using hazard ratios per 10-mm Hg/5-mm Hg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, DBP was analyzed separately for DBP <71 mm Hg and DBP <71 mm Hg. Stroke risk was associated positively with SBP and DBP <71 mm Hg (SBP/DBP <71 mm Hg; hazard ratios: 1.15/1.06 [95% CI: 1.12-1.18/1.03-1.09]) and negatively with DBP <71 mm Hg (0.88[0.79-0.98]). The hazard ratio for DBP decreased with age (P<0.001) and was not influenced by other cardiovascular risk factors. Taking into account the age×DBP interaction, both SBP and DBP <71 mm Hg were significantly associated with stroke risk until age 62 years, but in subjects older than 46 years the superiority of SBP for stroke risk exceeded that of DBP <71 mm Hg and remained significant until age 78 years. DBP <71 mm Hg became significant at age 50 years with an inverse relation to stroke risk. In Europeans, stroke risk should be assessed by both SBP and DBP until age 62 years with increased focus on SBP from age 47 years. From age 62 years, emphasis should be on SBP without neglecting the potential harm of very low DBP.

AB - This study investigates age-related shifts in the relative importance of systolic (SBP) and diastolic (DBP) blood pressures as predictors of stroke and whether these relations are influenced by other cardiovascular risk factors. Using 34 European cohorts from the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project with baseline between 1982 and 1997, 68 551 subjects aged 19 to 78 years, without cardiovascular disease and not receiving antihypertensive treatment, were included. During a mean of 13.2 years of follow-up, stroke incidence was 2.8%. Stroke risk was analyzed using hazard ratios per 10-mm Hg/5-mm Hg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, DBP was analyzed separately for DBP <71 mm Hg and DBP <71 mm Hg. Stroke risk was associated positively with SBP and DBP <71 mm Hg (SBP/DBP <71 mm Hg; hazard ratios: 1.15/1.06 [95% CI: 1.12-1.18/1.03-1.09]) and negatively with DBP <71 mm Hg (0.88[0.79-0.98]). The hazard ratio for DBP decreased with age (P<0.001) and was not influenced by other cardiovascular risk factors. Taking into account the age×DBP interaction, both SBP and DBP <71 mm Hg were significantly associated with stroke risk until age 62 years, but in subjects older than 46 years the superiority of SBP for stroke risk exceeded that of DBP <71 mm Hg and remained significant until age 78 years. DBP <71 mm Hg became significant at age 50 years with an inverse relation to stroke risk. In Europeans, stroke risk should be assessed by both SBP and DBP until age 62 years with increased focus on SBP from age 47 years. From age 62 years, emphasis should be on SBP without neglecting the potential harm of very low DBP.

U2 - 10.1161/HYPERTENSIONAHA.112.201400

DO - 10.1161/HYPERTENSIONAHA.112.201400

M3 - Journal article

C2 - 23006731

SN - 0194-911X

VL - 60

SP - 1117

EP - 1123

JO - Hypertension

JF - Hypertension

IS - 5

ER -

Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk: The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project

Abstract

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