The value of earlier-in-life systolic and diastolic blood pressure for cardiovascular risk prediction
Andreas Leiherer,
Wolfgang Brozek,
Axel Muendlein,
Hanno Ulmer,
Christoph H. Saely,
Peter Fraunberger,
Gabriele Nagel,
Emanuel Zitt,
Heinz Drexel,
Hans Concin
Affiliations
Andreas Leiherer
Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein; Medical Central Laboratories, Feldkirch, Austria; Corresponding author
Wolfgang Brozek
Agency for Preventive and Social Medicine, Bregenz, Austria
Axel Muendlein
Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
Hanno Ulmer
Agency for Preventive and Social Medicine, Bregenz, Austria; Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
Christoph H. Saely
Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
Peter Fraunberger
Private University in the Principality of Liechtenstein, Triesen, Liechtenstein; Medical Central Laboratories, Feldkirch, Austria
Gabriele Nagel
Agency for Preventive and Social Medicine, Bregenz, Austria; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
Emanuel Zitt
Agency for Preventive and Social Medicine, Bregenz, Austria; Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
Heinz Drexel
Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein; Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Drexel University College of Medicine, Philadelphia, PA, USA
Hans Concin
Agency for Preventive and Social Medicine, Bregenz, Austria; Corresponding author
Summary: Blood pressure (BP) varies over a lifetime. This cardiovascular observation study (OS) compared the predictive value of earlier- and later-in-life blood pressure (BP) in 1,497 cardiovascular disease patients utilizing readings taken during a health survey (HS) and 15 years later from the same subjects at the baseline of this OS. Prediction of the cardiovascular risk during the OS follow-up (21 years) was significantly more effective if the earlier BP readings at HS were used instead of recent OS readings (NRI = 0.30, p < 0.001). For HS readings, each 10 mm Hg increase of systolic and diastolic BP was associated with a 17% and 20% higher risk, respectively. At OS, systolic BP lost significance and diastolic BP reversed its association. Noteworthy, different BP categorizations (European vs. US guidelines) yielded similar results. This study highlights the poor predictive power of BP readings in elderly cardiovascular disease patients but emphasizes the significant prognostic value of earlier-in-life BP.
