Abstract
Aims: We aimed to determine the sex differences in longitudinal systolic and diastolic blood pressure (SBP and DBP) trajectories in mid-life and delineate the associations between these and mortality (all-cause, cardiovascular, non-cardiovascular) and incident cardiovascular disease (CVD) in old age.
Methods: Participants were selected from the European Prospective Investigation into Cancer, Norfolk (EPIC-Norfolk) cohort study. Sex-specific trajectories were determined using group-based trajectory models using three clinic BP measurements acquired between 1993 and 2012 (mean exposure ~12.9 years). Multivariable Cox regressions determined the associations between trajectories and incident outcomes over the follow-up (2012-2018, median follow-up 9.4 years).
Results: 2897 men (M) and 3819 women (F) were included. At baseline, women were younger (F-55.5, M-57.1), had a worse cardiometabolic profile and were less likely to receive primary CVD prevention including antihypertensive treatment (F-36.0%, M-42.0%). Over the exposure period, women had lower SBP trajectories while men exhibited more pronounced SBP decreases over this period. Over the follow-up period women had lower mortality (F-11.9%, M-20.5%) and CVD incidence (F-19.8%, M-29.6%). Compared to optimal SBP (≤120 mmHg) and DBP (≤70 mmHg) trajectories, hypertensive trajectories were associated with increased mortality and incident CVD in both men and women during follow-up at univariable level. These associations were nevertheless not maintained upon extensive confounder adjustment including antihypertensive therapies.
Conclusion: We report sex disparities in CVD prevention which may relate to worse cardiometabolic profiles and less pronounced longitudinal SBP decreases. Effective antihypertensive therapy may offset the adverse outcomes associated with prolonged exposure to high blood pressure.
Methods: Participants were selected from the European Prospective Investigation into Cancer, Norfolk (EPIC-Norfolk) cohort study. Sex-specific trajectories were determined using group-based trajectory models using three clinic BP measurements acquired between 1993 and 2012 (mean exposure ~12.9 years). Multivariable Cox regressions determined the associations between trajectories and incident outcomes over the follow-up (2012-2018, median follow-up 9.4 years).
Results: 2897 men (M) and 3819 women (F) were included. At baseline, women were younger (F-55.5, M-57.1), had a worse cardiometabolic profile and were less likely to receive primary CVD prevention including antihypertensive treatment (F-36.0%, M-42.0%). Over the exposure period, women had lower SBP trajectories while men exhibited more pronounced SBP decreases over this period. Over the follow-up period women had lower mortality (F-11.9%, M-20.5%) and CVD incidence (F-19.8%, M-29.6%). Compared to optimal SBP (≤120 mmHg) and DBP (≤70 mmHg) trajectories, hypertensive trajectories were associated with increased mortality and incident CVD in both men and women during follow-up at univariable level. These associations were nevertheless not maintained upon extensive confounder adjustment including antihypertensive therapies.
Conclusion: We report sex disparities in CVD prevention which may relate to worse cardiometabolic profiles and less pronounced longitudinal SBP decreases. Effective antihypertensive therapy may offset the adverse outcomes associated with prolonged exposure to high blood pressure.
| Original language | English |
|---|---|
| Article number | zwab104 |
| Pages (from-to) | 180-191 |
| Number of pages | 12 |
| Journal | European Journal of Preventive Cardiology |
| Volume | 29 |
| Issue number | 1 |
| Early online date | 5 Jul 2021 |
| DOIs | |
| Publication status | Published - 1 Jan 2022 |
Bibliographical note
ACKNOWLEDGEMENTSWe are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research.
We would also like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).
FUNDING
The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).
Keywords
- Blood pressure
- longitudinal
- sex-specific
- Cardiovascular disease
- trajectory
- mortality
Access to Document
- Pana_etal_EJPC_Long_Term_Prognotic_VoR
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.