Blood Pressure Changes Have a More Strong Impact on Short- than Long-Term Outcomes of Major Adverse Cardiovascular Events

Abstract

Background: Whether blood pressure (BP) changes have a different impact on short- and long-term outcomes of major adverse cardiovascular events (MACE) remains unclear. Therefore, we aimed to investigate and compare the effects of BP changes on short- and long-term outcomes of MACE. Methods: We conducted a prospective cohort study, which consisted of four examinations: baseline, 2008, 2010, and 2017 follow-up. BP changes were measured from baseline to 2008, short- and long-term outcomes were defined by incident events occurred from 2008 to 2010 and 2008 to 2017, respectively. The final analysis was restricted to 24,495 and 27,522 participants in short- and long-term analysis. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). The difference of β coefficients between short- and long-term outcomes were examined using Fisher Z test. Findings: During a median follow-up of 12·5-years, 451 (216 stroke, 33 myocardial infarction, 219 CVD deaths) and 2,025 (1,532 stroke, 371 myocardial infarction, 991 CVD deaths) MACE were identified during short- and longterms, respectively. For prehypertension to hypertension, the HR (95% CI) were 1·36 (1·00-1·84) for short-term MACE, 1·19 (1·01-1·40) for long-term stroke. For hypertension to prehypertension, 0·66 (0·49-0·91) for short-term MACE, 0·46 (0·27-0·78) for short-term stroke, 0·82 (0·69-0·97) for long-term stroke. Furthermore, short-term outcomes conferred a stronger impact than long-terms (measured as β coefficients, all P<0·05). Interpretation: BP changes were significantly associated with MACE and its subtypes for the short- and long-terms, and short-term outcomes conferred a strong impact than long-terms. Funding Statement: This research was partly supported by funds from National Nature Science Foundation of China (No. 81773510), Nature Science Foundation of Liaoning Province (No. 20170541048), National Key R&D Program of China (Grant #2017YFC1307600), and National Key R&D Program of China (Grant #2018YFC1311600). Declaration of Interests: The authors state: none. Ethics Approval Statement: The research protocol was approved by the China Medical University Research Ethics Committee, and written informed consent was formally obtained from all the participants or their guardians