TY - JOUR

T1 - Prediction of cardiovascular events from systolic or diastolic blood pressure

AU - Talebi, Atefeh

AU - Mortensen, Rikke Nørmark

AU - Gerds, Thomas Alexander

AU - Jeppesen, Jørgen Lykke

AU - Torp-Pedersen, Christian

N1 - Publisher Copyright: © 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

PY - 2022

Y1 - 2022

N2 - Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24-h ambulatory SBP and 24-h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause-specific Cox regression was performed to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular (CV) events. Also, the time-dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer-May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24-h ambulatory SBP and 24-h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p-value) was.26% (-.2% to.73%;.27) for 10-year CV mortality and.69% (-.09% to 1.46%;.082) for 10-year risk of CV events. The difference in AUC was.12% (-.2% to.44%;.46) for 10-year CV mortality and.04% (-.35 to.42%;.85) for 10-year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were.078 and.077, respectively. Furthermore, the Brier scores were.077 and.078 in CV mortality and CV events of 24-h ambulatory. For the average population as those participating in a population survey, the 10-year discriminative ability for long-term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.

AB - Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24-h ambulatory SBP and 24-h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause-specific Cox regression was performed to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular (CV) events. Also, the time-dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer-May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24-h ambulatory SBP and 24-h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p-value) was.26% (-.2% to.73%;.27) for 10-year CV mortality and.69% (-.09% to 1.46%;.082) for 10-year risk of CV events. The difference in AUC was.12% (-.2% to.44%;.46) for 10-year CV mortality and.04% (-.35 to.42%;.85) for 10-year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were.078 and.077, respectively. Furthermore, the Brier scores were.077 and.078 in CV mortality and CV events of 24-h ambulatory. For the average population as those participating in a population survey, the 10-year discriminative ability for long-term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.

KW - Brier score

KW - cardiovascular risk

KW - competing risks

KW - diastolic blood pressure

KW - predictive value

KW - systolic blood pressure

U2 - 10.1111/jch.14468

DO - 10.1111/jch.14468

M3 - Journal article

C2 - 35470947

AN - SCOPUS:85128706605

VL - 24

SP - 760

EP - 769

JO - Journal of Clinical Hypertension

JF - Journal of Clinical Hypertension

SN - 1524-6175

IS - 6

ER -