It remains unclear which blood pressure (BP) characteristics best predict cardiovascular risk in different age groups and between sexes. We leveraged data from the MORGAM (MONICA [Monitoring of Trends and Determinants in Cardiovascular Disease], Risk, Genetics, Archiving and Monograph) Project to investigate determinants of BP characteristics and their prognostic importance, in younger and older (P interaction <0.001). Higher systolic BP and mean BP were significantly associated with cardiovascular end point, irrespective of age group (P<0.001), but diastolic BP only demonstrated an independent relationship in the younger group (P<0.001). Brachial pulse pressure was associated with cardiovascular end point in the older age group (P<0.001). In subjects <50 years, diastolic BP significantly improved area under the receiver operating characteristic curve compared with Systematic Coronary Risk Evaluation variables (including systolic BP) alone (0.842 versus 0.840, P=0.03), enhanced continuous net reclassification improvement (0.150 [95% CI, 0.087-0.215]) and improved the prognostic value of the European Society of Cardiology/European Society of Hypertension hypertension definition (categorical net reclassification improvement=0.0255, P=0.005). In conclusion, diastolic BP may provide additional prognostic utility beyond systolic BP, in predicting composite cardiovascular events among younger individuals.
GrantsCounty council of Vastertbotten Swedish Heart and Lung Foundation Finnish Foundation for Cardiovascular research BiomarCaRE European Community FP 7 projects Consortium on Health and Ageing: Network of cohorts in Europe and the United States