Systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for prediction of cardiovascular events and mortality in a Middle Eastern population

Figures & data

Figure 1. Study population, *considering overlap among exclusions.

Table I. Mean and range of baseline blood pressure components in study population.

	All subjects (n = 5991)	Aged < 60 years (n = 4985)	Aged ≥ 60 years (n = 1006)
Systolic blood pressure	120 (77–220)	116 (77–219)	134 (84–203)
Diastolic blood pressure	78 (45–132)	78 (45–132)	79 (48–121)
Mean arterial pressure	92 (60–161)	91 (60–161)	97 (68–147)
Pulse pressure	41 (10–122)	39 (10–103)	54 (14–122)

Mean (minimum–maximum) of blood pressure components.

Table II. Comparison of baseline characteristics between participants with and without cardiovascular disease stratified by age.

	Age < 60 years			Age ≥ 60 years
	Without CVD (n = 4787)	With CVD (n = 198)	p-value	Without CVD (n = 858)	With CVD (n = 148)	p-value
Age (years)	41.8 ± 8.18	48.94 ± 7.19	<0.001	66.17 ± 5.23	66.34 ± 5.25	0.9
Sex (%male)	41.9	62.1	<0.001	55.6	70.3	0.7
Smoking (%)	22.3	34.8	<0.001	24.5	39.5	<0.001
Family history of CVD (%)	16.9	25.8	0.002	9.8	16.9	0.01
Diabetes (%)	5.4	28.3	<0.001	15.7	31.1	<0.001
Lifestyle intervention (%)	38.2	33.3	0.18	45.21	37.2	0.07
Body mass index (kg/m^2)	27.3 ± 4.7	28.7 ± 4.5	<0.001	26.7 ± 4.3	27.0 ± 4.0	0.5
Waist circumference (cm)	88.9 ± 11.3	95.5 ± 10.8	<0.001	91.8 ± 11.2	94.6 ± 11.2	0.005
Total cholesterol (mg/dl)	211 ± 44	239 ± 50	<0.001	226 ± 45	230 ± 47	0.3
Systolic blood pressure (mmHg)	116 ± 15	127 ± 21	<0.001	132 ± 20	140 ± 22	<0.001
Diastolic blood pressure (mmHg)	78 ± 10	82 ± 13	<0.001	79 ± 11	82 ± 13	0.02
Pulse pressure (mmHg)	38 ± 10	45 ± 13	<0.001	53 ± 16	58 ± 16	<0.001
Mean arterial pressure (mmHg)	91 ± 11	97 ± 15	<0.001	97 ± 13	101 ± 14	<0.001

Mean ± SD are shown for continuous variables and p-value is calculated with t-test; % is shown for categorical variables with p-value according to chi-square; CVD: cardiovascular disease.

Table III. Adjusted hazard rates and predictive utilities for different blood pressure (BP) measures and cardiovascular disease (CVD) outcome.

		Sex-adjusted model		Multivariate-adjusted model
	SD (mmHg)	HR (95% CI)	p-value	HR (95% CI)	p-value	C index (95% CI)	AIC
<60 years
SBP	15	1.69 (1.55–1.85)	<0.001	1.43 (1.26–1.61)	<0.001	0.81 (0.74–0.87)	3029
DBP	10	1.48 (1.32–1.67)	<0.001	1.24 (1.08–1.42)	0.003	0.80 (0.73–0.86)	3052
PP	10	1.61 (1.46–1.80)	<0.001	1.39 (1.23–1.57)	<0.001	0.80 (0.74–0.87)	3031
MAP	11	1.63 (1.46–1.82)	<0.001	1.37 (1.20–1.56)	<0.001	0.80 (0.74–0.87)	3040
≤60 years
SBP	20	1.39 (1.18–1.63)	<0.001	1.38 (1.18–1.63)	<0.001	0.66 (0.56–0.76)	1861
DBP	11	1.20 (1.03–1.41)	0.02	1.20 (1.00–1.44)	0.03	0.63 (0.54–0.73)	1872
PP	16	1.33 (1.14–1.56)	<0.001	1.29 (1.10–1.51)	<0.001	0.68 (0.58–0.77)	1865
MAP	13	1.32 (1.13–1.53)	<0.001	1.33 (1.11–1.60)	<0.001	0.64 (0.54–0.74)	1865

Multivariate models adjusted with sex, smoking status, family history of cardiovascular disease, diabetes, lifestyle intervention, body mass index, waist circumference, total cholesterol. SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure; SD, standard deviation; CI, confidence interval; HR, hazard ratios, indicating the increase risk for a 1SD increase in different BP measures; AIC, Akaike Information Criterion.

Table IV. Adjusted hazard ratios and discrimination of different blood pressure (BP) measures for predicting all-cause mortality.

		Sex-adjusted model		Multivariate adjusted model
	SD (mmHg)	HR (95% CI)	p-value	HR (95% CI)	p-value	C index (95% CI)	AIC
<60 years
SBP	15	1.64 (1.33–2.03)	<0.001	1.67 (1.35–2.06)	<0.001	0.70 (0.53–0.87)	719
DBP	10	1.47 (1.13–1.90)	0.004	1.47 (1.11–1.94)	0.006	0.76 (0.60–0.92)	728
PP	10	1.56 (1.25–1.95)	<0.001	1.55 (1.24–1.93)	<0.001	0.64 (0.44–0.83)	723
MAP	11	1.60 (1.26–2.03)	<0.001	1.62 (1.24–2.10)	<0.001	0.76 (0.61–0.92)	723
≥60 years
SBP	20	1.18 (1.00–1.38)	0.05	1.28 (1.04–1.56)	0.01	0.66 (0.55–0.77)	1430
DBP	11	0.92 (0.77–1.10)	0.41	1.05 (0.85–1.28)	0.67	0.68 (0.58–0.79)	1436
PP	16	1.29 (1.10–1.51)	0.002	1.29 (1.07–1.56)	0.005	0.66 (0.55–0.77)	1428
MAP	13	1.05 (0.88–1.26)	0.61	1.17 (0.95–1.44)	0.11	0.67 (0.56–0.78)	1433

Multivariate models adjusted with sex, smoking status, diabetes and body mass index. SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure; SD, standard deviation; CI, confidence interval; HR, hazard ratios, indicating the increase risk for a 1SD increase in different BP measures; AIC, Akaike Information Criterion.

Table V. Adjusted hazard ratios and discrimination of different blood pressure (BP) measures for predicting cardiovascular disease (CVD) mortality.

		Sex- and age-adjusted model		Multivariate-adjusted model
	SD (mmHg)	HR (95% CI)	p-value	HR (95% CI)	p-value	C index (95% CI)	AIC
SBP	18	1.35 (1.10–1.66)	0.003	1.35 (1.10–1.66)	0.004	0.88 (0.83–0.93)	918
DBP	10	1.13 (0.92–1.39)	0.2	1.16 (0.92–1.45)	0.2	0.88 (0.83–0.93)	924
PP	13	1.31 (1.10–1.56)	0.003	1.31 (1.07–1.60)	0.006	0.88 (0.83–0.93)	919
MAP	12	1.26 (1.03–1.56)	0.03	1.28 (1.02–1.61)	0.03	0.88 (0.83–0.93)	921

Multivariate models adjusted with sex, age, smoking status, diabetes, intervention, body mass index. SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; MAP, mean arterial pressure; SD, standard deviation; CI, confidence interval; HR, hazard ratios, indicating the increase risk for a 1SD increase in different BP measures; AIC, Akaike Information Criterion.