Document Detail


Impact of diastolic and systolic blood pressure on mortality: implications for the definition of "normal".
MedLine Citation:
PMID:  21404131     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The National Heart, Lung and Blood Institute currently defines a blood pressure under 120/80 as "normal."
OBJECTIVE: To examine the independent effects of diastolic (DBP) and systolic blood pressure (SBP) on mortality and to estimate the number of Americans affected by accounting for these effects in the definition of "normal." DESIGN, PARTICIPANTS AND MEASURES: Data on adults (age 25-75) collected in the early 1970s in the first National Health and Nutrition Examination Survey were linked to vital status data through 1992 (N = 13,792) to model the relationship between blood pressure and mortality rate adjusting for age, sex, race, smoking status, BMI, cholesterol, education and income. To estimate the number of Americans in each blood pressure category, nationally representative data collected in the early 1960s (as a proxy for the underlying distribution of untreated blood pressure) were combined with 2008 population estimates from the US Census.
RESULTS: The mortality rate for individuals over age 50 began to increase in a stepwise fashion with increasing DBP levels of over 90. However, adjusting for SBP made the relationship disappear. For individuals over 50, the mortality rate began to significantly increase at a SBP ≥ 140 independent of DBP. In individuals ≤ 50 years of age, the situation was reversed; DBP was the more important predictor of mortality. Using these data to redefine a normal blood pressure as one that does not confer an increased mortality risk would reduce the number of American adults currently labeled as abnormal by about 100 million.
CONCLUSIONS: DBP provides relatively little independent mortality risk information in adults over 50, but is an important predictor of mortality in younger adults. Conversely, SBP is more important in older adults than in younger adults. Accounting for these relationships in the definition of normal would avoid unnecessarily labeling millions of Americans as abnormal.
Authors:
Brent C Taylor; Timothy J Wilt; H Gilbert Welch
Publication Detail:
Type:  Journal Article     Date:  2011-03-15
Journal Detail:
Title:  Journal of general internal medicine     Volume:  26     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-16     Completed Date:  2011-10-06     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  685-90     Citation Subset:  IM    
Affiliation:
Department of Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA. Brent.Taylor2@va.gov
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects,  physiology*
Blood Pressure Determination
Cardiovascular Diseases / mortality*
Diastole / physiology
Female
Humans
Hypertension / mortality
Hypotension / mortality*
Logistic Models
Male
Middle Aged
Practice Guidelines as Topic
Predictive Value of Tests
Risk Factors
Systole / physiology
Time Factors
United States / epidemiology
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
J Gen Intern Med. 2011 Jul;26(7):678-80   [PMID:  21557032 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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