Abstract 12323: Cardiovascular Mortality Prediction Depends on the Time Point of Blood Pressure Measurement Rather Than on the Use of European versus US Blood Pressure Categorizations

Abstract

Introduction: Blood pressure (BP) is a predictor of cardiovascular risk but it changes during lifetime. Hypothesis: We hypothesize that there are differences in the value of systolic and diastolic blood pressure (BP) at different stages of life for predicting cardiovascular mortality risk, an issue which was addressed in this observation study (OS). Methods: At the baseline of the OS, BP was measured in 1497 cardiovascular disease patients at a median age of 65 years, and their outcome was recorded over 21 years. Fifteen years prior to the OS, the identical patients had participated in a health survey (HS) comprising BP measurement. The value of earlier (HS) vs. recent (OS) BP measurements for risk prediction was addressed using both guideline-defined BP categorizations from Europe (ESC/ESH) and the US (ACC/AHA). Results: BP at HS was a significantly better predictor of cardiovascular mortality than BP at OS (NRIESC/ESH=0.29, p<0.001; NRIACC/AHA=0.30, p<0.001). Each 10mm Hg increase was significantly positively associated with cardiovascular mortality for both systolic and diastolic blood pressure (HR=1.17 [1.11-1.23] and 1.20 [1.09-1.32], respectively) when measured at HS. In contrast, regarding systolic BP recorded at OS, the significant association with cardiovascular mortality (HR=1.04 [0.98-1.10]) was abrogated, and with diastolic BP the association has reversed (HR=0.82 [0.74-0.92]. In contrast, ESC/ESH and ACC/AHA BP categorizations were comparably valuable predicting cardiovascular mortality (NRIHS=0.04, p=0.563; NRIOS=0.02, p=0.817). Conclusions: Irrespective of categorization differences between European and US BP guidelines, earlier-in-life BP readings are valuable risk predictors for cardiovascular mortality and they outperform BP readings done at a more advanced age.