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Al Rifai M, Taffet GE, Matsushita K, Virani SS, De Lemos J, Khera A, Berry J, Ndumele C, Aguilar D, Sun C, Hoogeveen RC, Selvin E, Ballantyne CM, Nambi V. Age-Related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Cardiol 2023; 204:295-301. [PMID: 37567021 PMCID: PMC10528351 DOI: 10.1016/j.amjcard.2023.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
We sought to determine how biomarkers known to be associated with hypertension-induced end-organ injury complement the use of systolic blood pressure (SBP) for cardiovascular disease (CVD) risk prediction at different ages. Using data from visits 2 (1990 to 1992) and 5 (2011 to 2013) of the Atherosclerosis Risk in Communities (ARIC) study, 3 models were used to predict CVD (composite of coronary heart disease, stroke, and heart failure). Model A included traditional risk factors (TRFs) except SBP, model B-TRF plus SBP, and model C-TRF plus biomarkers (high-sensitivity troponin T [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]). Harrel's C-statistics were used to assess risk discrimination for CVD comparing models B and A and C and B. At visit 2, the addition of SBP to TRF (model B vs model A) significantly improved the C-statistic (∆C-statistic, 95% confidence interval 0.010, 0.007 to 0.013) whereas the addition of hsTnT to TRF (model C vs model B) decreased the C-statistic (∆C-statistic -0.0038, -0.0075 to -0.0001) compared with SBP. At visit 5, the addition of SBP to TRF did not significantly improve the C-statistic (∆C-statistic 0.001, -0.002 to 0.005) whereas the addition of both hsTnT and NT-proBNP to TRF significantly improved the C-statistic compared with SBP (∆C-statistic 0.028, 0.015 to 0.041 and 0.055, 0.036 to 0.074, respectively). In summary, the incremental value of SBP for CVD risk prediction diminishes with age whereas the incremental value of hsTnT and NT-proBNP increases with age.
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Affiliation(s)
- Mahmoud Al Rifai
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - George E Taffet
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland
| | - Salim S Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Aga Khan University, Karachi, Pakistan
| | - James De Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jarrett Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chiadi Ndumele
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Aguilar
- Division of Cardiology, Department of Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, Los Angeles
| | - Caroline Sun
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Ron C Hoogeveen
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland
| | - Christie M Ballantyne
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Section of Cardiovascular Research and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Department of Veterans Affairs Medical Center , Section of Cardiology, Houston, Texas.
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Baik I, Kim NH, Kim SH, Shin C. Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults. Epidemiol Health 2023; 45:e2023055. [PMID: 37309114 PMCID: PMC10482565 DOI: 10.4178/epih.e2023055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk. METHODS This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: 1) normal, SBP <120 mmHg and DBP <80 mmHg; 2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; 3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and 4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression. RESULTS Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals) were 1.36 (1.06-1.75) and 1.59 (1.06-2.39) for grade 1 and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years. CONCLUSIONS BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.
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Affiliation(s)
- Inkyung Baik
- Department of Foods and Nutrition, Kookmin University College of Sciences and Technologies, Seoul, Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong Hwan Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Chol Shin
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
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Tehrani DM, Fan W, Nambi V, Gardin J, Hirsch CH, Amsterdam E, deFilippi CR, Polonsky T, Wong ND. Trends in Blood Pressure and High-Sensitivity Cardiac Troponin-T With Cardiovascular Disease: The Cardiovascular Health Study. Am J Hypertens 2019; 32:1013-1020. [PMID: 31232455 PMCID: PMC6758940 DOI: 10.1093/ajh/hpz102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/16/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD. METHODS The Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2-3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120-139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5-13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up. RESULTS Among 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04-1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08-2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01). CONCLUSION An increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.
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Affiliation(s)
- David M Tehrani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Wenjun Fan
- Health Policy Research Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Julius Gardin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Calvin H Hirsch
- Department of Medicine, University of California Davis, Sacramento, California, USA
| | - Ezra Amsterdam
- Department of Medicine, University of California Davis, Sacramento, California, USA
| | | | - Tamar Polonsky
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Medical Sciences, University of California Irvine, Irvine, California, USA
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