Abstract 18849: Blood Pressure and Excess Cardiovascular Events in Middle-aged Adults
Introduction: Blood pressure (BP) is continuously associated with atherosclerotic cardiovascular disease (ASCVD) risk, even when BP is at goal levels.
Objectives: In this study, we sought to examine whether individuals at goal BP levels, who nonetheless experience ASCVD events, can be identified using multivariable risk assessment.
Methods: We stratified participants (45-64 years) from the Framingham Offspring Study (exams 4-6) and Atherosclerosis Risk in Communities Study (exams 1-4) based on systolic BP levels (<120, 120-129, 130-139, 140-149, 150-159, ≥160 mm Hg). We calculated risk of an incident ASCVD event over 10 years using Cox models. We determined the number of excess ASCVD events in each BP stratum by calculating the difference between observed and expected number of events (with the ASCVD rate in SBP < 120 group used as referent). We estimated 10-year ASCVD risk at baseline for each participant using the 2013 ACC/AHA Pooled Cohort risk equations.
Results: There were 14,985 participants (80% white; 20% black) followed for 10 years. There were a total of 755 ASCVD events (556 excess ASCVD events). The risk of an ASCVD event at 10 years was greater for each higher BP stratum (adjusted HRs 1.64, 1.70, 1.94, 2.97, and 4.74, respectively). Of the excess events, 54% (301/556) occurred in those with SBP ≥120 but <140. Among these participants, 71% (214/301) had a 10-year ASCVD risk ≥7.5% and 85% (256/301) had a 10-year ASCVD risk ≥5%. Of all the excess ASCVD events, 79% (441/556) occurred in participants with 10-year ASCVD risk ≥7.5% and 89% (495/556) occurred in participants with 10-year ASCVD risk ≥5%.
Conclusions: A majority of excess ASCVD events occur in individuals with SBP ≥120 but <140 mm Hg. Multivariable risk estimation may help identify individuals likely to benefit from risk reducing therapies. These results support consideration of multivariable risk estimation in guiding preventive therapy across the spectrum of BP.
Author Disclosures: K.N. Karmali: None. H. Ning: None. D.M. Lloyd-Jones: None.
- © 2014 by American Heart Association, Inc.