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Impact Of Diastolic And Systolic Blood Pressure On Mortality: Implications For The Definition Of “Normal”

Brent C. Taylor, Timothy J. Wilt, H Gilbert Welch
Published 2011 · Medicine
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ABSTRACTBACKGROUNDThe National Heart, Lung and Blood Institute currently defines a blood pressure under 120/80 as “normal.”OBJECTIVETo 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 MEASURESData 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.RESULTSThe 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.CONCLUSIONSDBP 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.
This paper references
10.1016/S0140-6736(02)11911-8
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
Sarah Lewington (2002)
10.1016/0021-9681(84)90070-5
Labelling in hypertension: a review of the behavioural and psychological consequences.
Lorna Macdonald (1984)
Changing disease definitions: implications for disease prevalence. Analysis of the Third National Health and Nutrition Examination Survey, 1988-1994.
Lisa M. Schwartz (1999)
10.1001/jama.1993.03510240036013
The treatment of mild hypertension study.
Edward B. Nelson (1993)
10.1007/BF02600842
How serious are the adverse effects of screening?
William Feldman (2007)
10.1056/NEJM196705042761804
The morbidity of cardiac nondisease in schoolchildren.
A. Buesink W.A. Bergman (1967)
10.1056/NEJMoa0802743
Effects of intensive glucose lowering in type 2 diabetes.
Hertzel C. Gerstein (2008)
10.1001/jama.1993.03510060059034
Treatment of Mild Hypertension Study: Final Results
James D. Neaton (1993)
10.1001/jama.270.6.713
Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group.
James D. Neaton (1993)
10.2105/AJPH.77.1.45
Evaluation of public health preschool child developmental screening: the process and outcomes of a community program.
David Cadman (1987)
10.1001/jama.289.19.2560
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report
Aram V. Chobanian (2003)
10.1161/01.CIR.86.3.1026
Health policy on blood cholesterol. Time to change directions.
Stephen B. Hulley (1992)
10.1001/jama.2010.884
Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease.
Rhonda M. Cooper‐DeHoff (2010)
10.1161/01.CIR.77.3.504
Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial.
Gale H. Rutan (1988)



This paper is referenced by
10.23886/ejki.5.5895.44-9
Combination of Glasgow Coma Scale, Age, and Systolic Blood Pressure in Assessing Patients’ Outcomes with Decreased Consciousness
Amir Sjarifuddin Madjid (2017)
10.3233/JAD-190474
Midlife Hypertension and Alzheimer's Disease: A Systematic Review and Meta-Analysis.
Matthew Lennon (2019)
The Effects Of Upper Body vs Lower Body Training On Rate-Pressure Product
Zanae Baird (2012)
10.1016/j.ijmedinf.2017.02.012
The ability of older adults to use customized online medical databases to improve their health-related knowledge
Ophir Freund (2017)
10.1155/2013/178780
Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients
Steven Tringali (2013)
10.1093/aje/kww206
Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995–2008
Adam M Lippert (2017)
10.1161/CIRCULATIONAHA.118.035521
Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort: 1990 to 2015
Tali Elfassy (2019)
10.1111/ggi.12097
High normotension is associated with higher metabolic syndrome risk in postmenopausal women.
Chun-Hsien Hsu (2014)
Using Incentives in Workplace Wellness Programs: The Impact of Federal Employment Discrimination Laws
Edie Lindsay (2013)
10.1007/978-3-319-95655-8_14
Evaluation and Treatment of Hypertension
Quang Trinh Nguyen (2019)
10.1016/j.compbiomed.2018.09.013
Arterial blood pressure feature estimation using photoplethysmography
Armin Soltan Zadi (2018)
10.1038/ejcn.2015.88
A combination of isolated phytochemicals and botanical extracts lowers diastolic blood pressure in a randomized controlled trial of hypertensive subjects
Stanislaus Biesinger (2016)
10.1080/15401383.2018.1425941
The Effects of Animal-Assisted Activities on College Students Before and After a Final Exam
JoAnn Jarolmen (2018)
10.1007/s00115-014-4110-y
Abschätzung von Prävalenz und Behandlungsbedarf psychischer Störungen
Frank Jacobi (2014)
10.1016/j.socscimed.2017.12.025
Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk.
Jennifer W. Robinette (2018)
10.1007/978-1-4471-2789-5_11
Hypertension in the Young Adult
Klaus K Witte (2015)
10.1016/j.jamda.2016.02.013
Neglected Categorical Differences of Hypertension of the Elderly vs. the Young: A Case of Institutional Amnesia?
Gerson T. Lesser (2016)
10.1111/jch.13057
Independent association between age and circadian systolic blood pressure patterns in adults with hypertension.
Ming Ming Deng (2017)
10.4067/s0034-98872017000800996
[Risk factors associated with hypertension. Analysis of the 2009-2010 Chilean health survey].
Fanny Petermann (2017)
10.17116/profmed20202301177
Total 10-year risk of death from cardiovascular disease in 25—64 year-old men in Tyumen
Georgiy Pushkarev (2020)
A Profile of Young Hypertensive Patients at a Tertiary Care Hospital in South India
George Krupa (2016)
10.21776/ub.jkb.2018.030.02.14
Faktor Dominan dalam Memprediksi Mortalitas Pasien dengan Sepsis di Unit Gawat Darurat
Ilham Akbar (2018)
10.1093/abm/kaz017
Ambivalence in the Early Years of Marriage: Impact on Ambulatory Blood Pressure and Relationship Processes.
W. Birmingham (2019)
The influence of biofeedback sessions in closed loop of heart rate variability and paced breathing on systolic blood pressure control during standard drug therapy in patients with arterial hypertension
S. A. S. Belal (2015)
10.5220/0008238400050010
The Impact of Short Message Service (SMS) Reminder and Home Monitoring on Blood Pressure Control in Hypertension Patients: A Case Study of Two Primary Health Care Facilities in Banyumas Regency
Laksmi Maharani (2018)
Evaluation of In Vivo Antihypertensive and Ex Vivo V asodepressor Activities of the Seed Extract of Calpurnia aurea (Ait.) Benth.subsp. aurea (Fabaceae)
Yohannes Getiye (2014)
Impedancias basales registradas durante la denervación renal por radiofrecuencia en pacientes con hipertensión arterial resistente
J. C. Estupiñan (2016)
10.1016/j.jiph.2019.12.010
Attributable risk of all-cause mortality in hypertensive adults based on disease risk prediction model: A Chinese cohort study.
Weiwei Sun (2020)
10.1016/j.ienj.2019.100787
Association of blood pressure documentation with adverse outcomes in an emergency department in Brazil.
A. C. Q. G. Daniel (2019)
Patterns of Dyslipidaemia in Prehypertensive and Normotensive Subjects
Usman Wali (2015)
A Study on Visual , Brainstem Auditory and Cognitive Evoked Potential In Prehypertension And Hypertension ” In Saraswathi Institute of Medical Sciences Hapur Uttar Pradesh
Dr. Manisha Shrivastwa (2018)
10.3390/APP9112236
Photoplethysmography-Based Continuous Systolic Blood Pressure Estimation Method for Low Processing Power Wearable Devices
Rolandas Gircys (2019)
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