Abstract 15476: Relation of Blood Pressure Indices with Differential Risk for Cardiovascular Events: The Atherosclerosis Risk in Communities Study

Abstract

BACKGROUND: Distinct components of blood pressure (BP) elevation include measures of pulsatile versus steady state load. The extent to which distinct BP components may be associated with varying risk for different cardiovascular outcomes remains uncertain.

METHODS: We studied 10,007 participants (mean age 54±6 years, 56% women, 21% African American) of the Atherosclerosis Risk in Communities Study who were free of cardiovascular disease at baseline. We used Cox proportional hazards models to compare the contributions of systolic (SBP), diastolic (DBP), pulse pressure (PP), and mean arterial pressure (MAP) to risk for coronary heart disease (CHD), heart failure (HF), stroke, and all-cause mortality. A larger -2 log-likelihood difference for a model with a single BP measure removed (compared to a full model with 2 measures being compared) was considered to reflect a greater contribution of that BP measure to risk for the given outcome.

RESULTS: A total of 1537 CHD events, 951 HF events, 550 stroke events, and 2194 deaths occurred during up to 21 years of follow up. Incidence rates of CHD, HF, and all-cause mortality were particularly high among individuals in the upper quartile of PP; incidence of stroke was particularly high among individuals in the upper quartile of SBP (Table). In multivariable analyses adjusting for traditional cardiovascular risk factors, the BP measures with the greatest contributions to risk were: SBP for CHD (P<0.0001 for -2 log-likelihood difference from the model including the next strongest BP predictor); PP for HF (P<0.0001), SBP for stroke (P=0.020), and PP for all-cause mortality (P<0.0001).

CONCLUSION: Extending from prior studies, our data indicate that distinct measures of BP contribute variably to different outcomes. Further studies are needed to investigate the specific arterial hemodynamics represented by components of BP elevation in the effort to elucidate the pathways that increase risk for specific cardiovascular outcomes.