DOI QR코드

DOI QR Code

Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study

  • Yi, Sang-Wook (Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine) ;
  • Ohrr, Heechoul (Department of Preventive Medicine, Yonsei University College of Medicine)
  • Received : 2015.01.21
  • Accepted : 2015.02.23
  • Published : 2015.03.31

Abstract

Objectives: Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men. Methods: From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004. Results: Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older. Conclusions: Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older.

Keywords

References

  1. Kim J, Gall SL, Nelson MR, Sharman JE, Thrift AG. Lower systolic blood pressure is associated with poorer survival in long-term survivors of stroke. J Hypertens 2014;32(4):904-911. https://doi.org/10.1097/HJH.0000000000000098
  2. Bangalore S, Messerli FH, Wun CC, Zuckerman AL, DeMicco D, Kostis JB, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J 2010;31(23):2897-2908. https://doi.org/10.1093/eurheartj/ehq328
  3. Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP; INDANA Project Steering Committee. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 2002;136(6):438-448. https://doi.org/10.7326/0003-4819-136-6-200203190-00007
  4. Dorresteijn JA, van der Graaf Y, Spiering W, Grobbee DE, Bots ML, Visseren FL, et al. Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease: J-curve revisited. Hypertension 2012;59(1):14-21. https://doi.org/10.1161/HYPERTENSIONAHA.111.179143
  5. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006;144(12):884-893. https://doi.org/10.7326/0003-4819-144-12-200606200-00005
  6. Sleight P, Redon J, Verdecchia P, Mancia G, Gao P, Fagard R, et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens 2009;27(7):1360-1369. https://doi.org/10.1097/HJH.0b013e32832d7370
  7. Ronnback M, Isomaa B, Fagerudd J, Forsblom C, Groop PH, Tuomi T, et al. Complex relationship between blood pressure and mortality in type 2 diabetic patients: a follow-up of the Botnia Study. Hypertension 2006;47(2):168-173. https://doi.org/10.1161/01.HYP.0000199667.30253.b7
  8. Mancia G, Grassi G, Zanchetti A. Antihypertensive treatment and blood pressure in diabetic and nondiabetic patients: the lower, the better? Diabetes Care 2011;34 Suppl 2:S304-S307. https://doi.org/10.2337/dc11-s244
  9. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360(9349):1903-1913. https://doi.org/10.1016/S0140-6736(02)11911-8
  10. Kannel WB, D’Agostino RB, Silbershatz H. Blood pressure and cardiovascular morbidity and mortality rates in the elderly. Am Heart J 1997;134(4):758-763. https://doi.org/10.1016/S0002-8703(97)70061-9
  11. Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, et al. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 2005;45(2):240-245. https://doi.org/10.1161/01.HYP.0000152079.04553.2c
  12. Yi SW, Hong S, Ohrr H. Low systolic blood pressure and mortality from all-cause and vascular diseases among the rural elderly in Korea; Kangwha cohort study. Medicine (Baltimore) 2015;94(2):e245. https://doi.org/10.1097/MD.0000000000000245
  13. Yi SW, Hong JS, Ohrr H, Yi JJ. Agent Orange exposure and disease prevalence in Korean Vietnam veterans: the Korean veterans health study. Environ Res 2014;133:56-65. https://doi.org/10.1016/j.envres.2014.04.027
  14. Yi SW, Ohrr H, Hong JS, Yi JJ. Agent Orange exposure and prevalence of self-reported diseases in Korean Vietnam veterans. J Prev Med Public Health 2013;46(5):213-225. https://doi.org/10.3961/jpmph.2013.46.5.213
  15. Hakala SM, Tilvis RS, Strandberg TE. Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki Ageing Study. Eur Heart J 1997;18(6):1019-1023. https://doi.org/10.1093/oxfordjournals.eurheartj.a015360
  16. Messerli FH, Panjrath GS. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol 2009;54(20):1827-1834. https://doi.org/10.1016/j.jacc.2009.05.073
  17. Tormo MJ, Navarro C, Chirlaque MD, Barber X. Validation of self diagnosis of high blood pressure in a sample of the Spanish EPIC cohort: overall agreement and predictive values. EPIC Group of Spain. J Epidemiol Community Health 2000;54(3):221-226. https://doi.org/10.1136/jech.54.3.221
  18. Yi SW, Ryu SY, Ohrr H, Hong JS. Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study. Int J Epidemiol 2014;43(6):1825-1834. https://doi.org/10.1093/ije/dyu183
  19. Yi SW, Odongua N, Nam CM, Sull JW, Ohrr H. Body mass index and stroke mortality by smoking and age at menopause among Korean postmenopausal women. Stroke 2009;40(11):3428-3435. https://doi.org/10.1161/STROKEAHA.109.555144

Cited by

  1. Low Systolic Blood Pressure and Vascular Mortality Among More Than 1 Million Korean Adults vol.133, pp.24, 2016, https://doi.org/10.1161/circulationaha.115.020752
  2. Relationship between systolic blood pressure and all-cause mortality: a prospective study in a cohort of Chinese adults vol.18, pp.1, 2015, https://doi.org/10.1186/s12889-017-4965-5
  3. Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort vol.72, pp.12, 2015, https://doi.org/10.1136/jech-2018-211050