Association of blood pressure components with mortality and cardiovascular events in prehypertensive individuals: a nationwide population-based cohort study

Figures & data

Figure 1. Flow diagram.

Table 1. Baseline characteristics among the prehypertensive healthy examinees.

Variables		All-cause mortality		p-value	Cardiovascular event		p-value
	Total(N = 30,258)	Survivor	Non-survivor		Non-event	Event
		(N = 29,561)	(N = 697)		(N = 28,876)	(N = 1,382)
Age $\ge$50, n(%)	10,734 (35.5)	10,157 (34.4)	577 (82.8)	<.001	9,889 (34.2)	845 (61.1)	<.001
Male sex, n(%)	18,873 (62.4)	18,342 (62)	531 (76.2)	<.001	17,963 (62.2)	910 (65.8)	.006
Body mass index, kg/m^2	23.7 ± 2.7	23.7 ± 2.7	23 ± 3.0	<.001	23.7 ± 2.7	23.7 ± 2.9	.903
Comorbidities, n (%)
Cancer	132 (0.4)	115 (0.4)	17 (2.4)	<.001	121 (0.4)	11 (0.8)	.062
Acute myocardial infraction	3 (0.01)	3 (0.01)	0 (0)	>.999	2 (0.01)	1 (0.07)	.131
Congestive heart failure	100 (0.3)	88 (0.3)	12 (1.7)	<.001	85 (0.3)	15 (1.1)	<.001
SBP, mmHg	123.9 ± 7.0	123.8 ± 7.0	124.8 ± 7.3	.001	123 ± 8 7	124.6 ± 7.2	<.001
DBP, mmHg	78.1 ± 5.4	78.1 ± 5.3	77.6 ± 5.9	.028	78.1 ± 5.3	78.1 ± 5.6	.760
PP, mmHg	45.7 ± 8.5	45.7 ± 8.5	47.2 ± 9.2	<.001	45.7 ± 8.5	46.5 ± 8.9	.001
MAP, mmHg	93.4 ± 4.4	93.4 ± 4.4	93.4 ± 4.7	.983	93.4 ± 4.4	93.6 ± 4.5	.080
Charlson comorbidity index	0.38 ± 0.7	0.37 ± 0.7	0.61 ± 0.9	<.001	0.36 ± 0.7	0.54 ± 0.9	<.001
Laboratory data
Fasting blood glucose, mg/dL	86.2 ± 8.6	86.2 ± 8.6	86.1 ± 8.8	.722	86.2 ± 8.6	86.1 ± 8.5	.734
Total cholesterol, mg/dL	196.2 ± 35.2	196.4 ± 35.1	190.6 ± 38.5	<.001	196 ± 35.1	200.5 ± 38.0	<.001
Hemoglobin, g/dL	14.1 ± 1.5	14.1 ± 1.5	14 ± 1.4	.093	14.1 ± 1.5	14.1 ± 1.4	.719
Proteinuria, n (%)				.031			.033
–	29,594 (97.8)	28,924 (97.8)	670 (96.1)		28,257 (97.9)	1,337 (96.7)
±	318 (1.1)	304 (1.0)	14 (2.0)		297 (1)	21 (1.5)
+	256 (0.8)	246 (0.8)	10 (1.4)		235 (0.8)	21 (1.5)
++	75 (0.2)	72 (0.2)	3 (0.4)		72 (0.2)	3 (0.2)
$\ge$+++	15 (0.05)	15 (0.05)	0 (0)		15 (0.1)	0 (0)
Smoking, n(%)				<.001			.002
Non or Past smoker	21,807 (72.1)	21,357 (72.2)	450 (64.6)		20,861 (72.2)	946 (68.5)
Current smoker	7,426 (24.5)	7,202 (24.4)	224 (32.1)		7,032 (24.4)	394 (28.5)
Missing	1025 (3.4)	1002 (3.4)	23 (3.3)		983 (3.4)	42 (3.0)

Data are expressed as mean (with standard deviation) or n (%).

SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure; CI: confidence rate.

Table 2. Incidence rate for all-cause mortality and CV events per 1,000 person-years in each group.

	All-cause mortality	CV events
	Events/1,000 person-years (95% CI)	Events/1,000 person-years (95% CI)
Prehypertensive population	2.60 (2.41–2.80)	4.99 (4.72–5.26)
Normal-range BP population	2.15 (1.95–2.37)	3.90 (3.62–4.19)

Person-time rate and 95% confidence intervals are tested by Mid-P exact test.

CV: cardiovascular; CI: confidence interval; BP: blood pressure.

Table 3. Baseline characteristics among the healthy examinees who had normal-range blood pressure.

Variables		All-cause mortality		p-value	Cardiovascular event		p-value
	Total(N = 20,965)	Survivor	Non-survivor		Non-event	Event
		(N = 20,564)	(N = 401)		(N = 20,212)	(N = 753)
Age $\ge$50, n (%)	6,511 (31.1)	6,197 (30.1)	314 (78.3)	<.001	6,107 (30.2)	404 (53.7)	<.001
Male sex, n (%)	9,841 (46.9)	9,560 (46.5)	281 (70.1)	.001	9,443 (46.7)	398 (52.9)	.001
Body mass index, kg/m^2	22.9 ± 2.6	22.9 ± 2.6	22.2 ± 3	.001	22.9 ± 2.6	23.3 ± 3.0	<.001
Comorbidities, n (%)
Cancer	138 (0.7)	125 (0.6)	13 (3.2)	.001	132 (0.7)	6 (0.8)	.641
Acute myocardial infraction	3 (0.01)	3 (0.01)	0 (0)	>.999	2 (0.01)	1 (0.13)	.104
Congestive heart failure	48 (0.2)	41 (0.2)	7 (1.7)	.001	37 (0.2)	11 (1.5)	<.001
SBP, mmHg	106.6 ± 7.1	106.6 ± 7.1	106.6 ± 7.4	.868	106.6 ± 7.1	107 ± 7.2	.103
DBP, mmHg	66.8 ± 5.9	66.8 ± 5.9	66.4 ± 5.9	.159	66.8 ± 5.9	67 ± 5.8	.073
PP, mmHg	39.8 ± 6.3	39.7 ± 6.3	40.2 ± 7.0	.172	39.8 ± 6.3	39 ± 6.4	.825
MAP, mmHg	80.1 ± 5.6	80.1 ± 5.6	79.8 ± 5.5	.355	80.1 ± 5.6	80.5 ± 5.5	.051
Laboratory data
Fasting blood glucose, mg/dL	85.7 ± 8.5	85.7 ± 8.5	84.9 ± 9.0	.100	85.6 ± 8.5	86.3 ± 8.3	.024
Total cholesterol, mg/dL	191.1 ± 34.5	191.1 ± 34.4	189.6 ± 40.2	.454	190.9 ± 34.4	196.6 ± 36.7	<.001
Hemoglobin, g/dL	13.6 ± 1.5	13.6 ± 1.5	13.6 ± 1.7	.791	13.6 ± 1.5	13.7 ± 1.5	.120
Proteinuria, n (%)				.864
–	20,506 (97.8)	20,113 (97.8)	393 (98)		19,769 (97.8)	737 (97.9)	.955
±	249 (1.2)	244 (1.2)	5 (1.2)		241 (1.2)	8 (1.1)
+	167 (0.8)	164 (0.8)	3 (0.7)		160 (0.8)	7 (0.9)
++	35 (0.2)	35 (0.2)	0 (0)		34 (0.2)	1 (0.1)
$\ge$+++	8 (0.04)	8 (0.04)	0 (0)		8 (0)	0 (0)
Smoking, n (%)				.001			.002
Non or past smoker	16,131 (76.9)	15,877 (77.2)	254 (63.3)		15,586 (77.1)	545 (72.4)
Current smoker	4,134 (19.7)	3,996 (19.4)	138 (34.4)		3,948 (19.5)	186 (24.7)
Missing	700 (3.3)	691 (3.4)	9 (2.2)		678 (3.4)	22 (2.9)

Data are expressed as mean (with standard deviation) or n (%).

SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure.

Figure 2. Hazard ratios for all-cause mortality and cardiovascular events. Multivariate proportional regression analyses of the prehypertensive group and the normal-range BP group. SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure; CV: cardiovascular.

Table 4. Multiple cox proportional regression analysis for all-cause mortality and cardiovascular events among the prehypertensive group.

	All-cause mortality				Cardiovascular event
	Number of Event = 697				Number of Event = 1,382
	HR	95% CI		p-value	HR	95% CI		p-value
SBP (per 10 mmHg increase)	1.121	1.006	1.25	.039	1.090	1.010	1.177	.027
DBP (per 10 mmHg increase)	0.891	0.780	1.017	.087	0.998	0.904	1.101	.968
PP (per 10 mmHg increase)	1.13	1.036	1.233	.006	1.060	0.996	1.129	.066
MAP (per 10 mmHg increase)	0.973	0.821	1.152	.747	1.072	0.95	1.209	.259

Adjusted for age, sex, BMI, total cholesterol concentrations, smoking status and Charlson comorbidity index (CCI).

SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure; HR: hazard ratio; CI: confidence interval.

Table 5. Multivariate cox proportional regression analysis for all-cause mortality and cardiovascular events among the population with normal-ranged blood pressure.

	All-cause mortality				Cardiovascular event
	HR	95% CI		p-value	HR	95% CI		p-value
SBP (per 10 mmHg increase)	0.991	0.863	1.138	.902	1.033	0.931	1.146	.543
DBP (per 10 mmHg increase)	0.864	0.735	1.015	.075	1.059	0.935	1.2	.366
PP (per 10 mmHg increase)	1.122	0.964	1.306	.136	0.991	0.885	1.109	.871
MAP (per 10 mmHg increase)	0.89	0.748	1.058	.187	1.063	0.931	1.215	.367

Adjusted for age, sex, BMI, total cholesterol concentrations, smoking status and Charlson comorbidity index (CCI).

SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure; HR: hazard ratio; CI: confidence interval.

Table 6. Multivariate cox proportional regression analysis for all-cause mortality and cardiovascular events among the prehypertensive group according to stratified DBP.

		All-cause mortality				Cardiovascular event
	N	HR	95% CI		p-value	HR	95% CI		p-value
80 ≤ DBP <90 mmHg	21,323
SBP (per 10 mmHg increase)		1.037	0.917	1.172	.563	1.030	0.947	1.121	.488
PP (per 10 mmHg increase)		1.036	0.911	1.178	.590	1.020	0.933	1.115	.669
MAP (per 10 mmHg increase)		1.081	0.817	1.429	.587	1.100	0.907	1.333	.332
DBP <80 mmHg	8,935
SBP (per 10 mmHg increase)		1.426	1.138	1.787	.002	1.388	1.171	1.646	<.001
PP (per 10 mmHg increase)		1.396	1.160	1.681	<.001	1.285	1.111	1.485	.001
MAP (per 10 mmHg increase)		1.095	0.781	1.536	.599	1.243	0.965	1.601	.092

Adjusted for age, sex, BMI, total cholesterol concentrations, smoking status and Charlson comorbidity index (CCI).

SBP: systolic blood pressure; DBP: diastolic blood pressure; PP: pulse pressure; MAP: mean arterial pressure; HR: hazard ratio; CI: confidence interval.

Figure 3. The frequency of cause of death in the current study.

Table

C	Neoplasms
I	Circulatory system
T	Certain other consequences of external causes
S	Injury and poisoning
J	Respiratory system
R	Symptoms, signs and abnormal clinical and lab findings
K	Digestive system
A&B	Infectious and parasitic diseases
D	Neoplasms, blood, blood-forming organs
N	Genitourinary system