Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects ( n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

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Lower peak systolic blood pressure during exercise testing predicts higher risk of all-cause mortality even when accounting for exercise capacity and other confounders

European Heart Journal ◽

10.1093/ehjci/ehaa946.3083 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Hedman ◽

T Lindow ◽

A Carlen ◽

N Cauwenberghs ◽

V Elmberg ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Exercise Capacity ◽

Exercise Testing ◽

Funding Source ◽

Risk Of Death ◽

Increased Risk ◽

Ergometer Exercise ◽

All Cause Mortality ◽

Cardiac Medication

Abstract Background The risk associated with an exaggerated systolic blood pressure (SBP) response during exercise testing is controversial. In part, this may be due to the confounding effect of exercise capacity, as achieving a high workload is related to both better survival and higher peak SBP. Purpose We aimed to determine the prognostic value of the SBP response at clinical exercise testing, with and without accounting for exercise capacity and other important confounders, for predicting all-cause mortality. Methods We analysed data from 10,245 subjects aged 18–85 years (54% male), referred for bicycle ergometer exercise testing at a single hospital between 2005 and 2015. Resting SBP, peak SBP, peak Watt as well as the first and last SBP and corresponding Watt during exercise were retrieved. The slope of the increase in SBP per increment in Watt between the first and last measurement during exercise (the SBP/Watt-slope) was calculated. Survival status was determined from the National Cause of Death register up until April 2019. Cox proportional hazard ratios for all-cause mortality were calculated in males and females for peak SBP and the SBP/Watt-slope, and natural cubic spline models (with three knots) were computed to explore the risk of death based on a continuum of each SBP measure. The models were adjusted for age, SBP at rest, a diagnosis of diabetes, hypertension, baseline cardiovascular disease (ICD10 Chapter IX) and the use of cardiac and/or antihypertensive medications. In additional analyses, peak SBP and the SBP/Watt-slope were adjusted for peak Watt or exercise capacity (% predicted), respectively. Results Over a median follow-up of 7.9 (IQR 5.7) years, 890 (8.7%) subjects died. Compared to survivors, subjects who died were older (69±10 vs 57±14 years, p<0.001), had lower age-adjusted exercise capacity (82±15 vs 92±17% pred. Watt, p<0.001), and had lower peak SBP (193±28 vs 196±26 mmHg, p=0.002). The SBP/Watt-slope was on average 21% higher in those who died (0.64±0.36 vs 0.53±0.27 mmHg/Watt, p<0.001). An exercise peak SBP <190 mmHg in females and <210 mmHg in males was associated with increased risk of all-cause death, after adjusting for age, prevalent comorbidities, cardiac medication and exercise capacity at baseline (Figure 1). After adjusting for maximal workload, higher peak SBP was associated with increased risk of dying in females, but not in males. An SBP/Watt-slope >0.5 mmHg/Watt was associated with higher risk of death in both sexes, although not when adjusting for exercise capacity. Conclusion Achieving a lower peak SBP was associated with increased risk of all-cause mortality in both sexes. This persisted after accounting for exercise capacity and other important confounders. In females, but not in males, there was also an increased risk of death associated with higher peak SBP. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): County Council of Ostergotland

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Abstract 14652: Systolic Blood Pressure Trajectories and Cardiovascular Outcomes in SPRINT

Circulation ◽

10.1161/circ.142.suppl_3.14652 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Charles A German ◽

Tali Elfassy ◽

Matthew J Singleton ◽

Carlos J Rodriguez ◽

Walter T Ambrosius ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Latent Class ◽

Stable Group ◽

Coronary Syndrome ◽

Average Blood Pressure ◽

Increased Risk ◽

All Cause Mortality ◽

Over Time

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

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Lower serum retinoic acid level for prediction of higher risk of mortality in ischemic stroke

Neurology ◽

10.1212/wnl.0000000000007261 ◽

2019 ◽

Vol 92 (15) ◽

pp. e1678-e1687 ◽

Cited By ~ 22

Author(s):

Wen-Jun Tu ◽

Han-Cheng Qiu ◽

Yiqun Zhang ◽

Jian-lei Cao ◽

Hong Wang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Retinoic Acid ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Net Reclassification Improvement ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Cvd Mortality

ObjectiveTo explore the association between serum retinoic acid (RA) level in patients with acute ischemic stroke (AIS) and mortality risk in the 6 months after admission.MethodsFrom January 2015 through December 2016, patients admitted to 3 stroke centers in China for first-ever AIS were screened. The primary endpoint was all-cause mortality or cardiovascular disease (CVD) mortality in the 6 months after admission. The significance of serum RA level, NIH Stroke Scale score, and established risk factors in predicting mortality were determined. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) statistics were applied in statistical analysis.ResultsOf the 1,530 patients enrolled, 325 died within 6 months of admission, with an all-cause mortality of 21.2% and CVD-related mortality of 13.1%. In multivariable analysis, RA levels were expressed as quartiles with the clinical variables. The results of the second to fourth quartiles (Q2–Q4) were compared with the first quartile (Q1); RA levels showed prognostic significance, with decreased all-cause and CVD mortality of 55% and 63%, respectively. After RA was added to the existing risk factors, all-cause mortality could be better reclassified, in association with only the NRI statistic (p = 0.005); CVD mortality could be better reclassified with significance, in association with both the IDI and NRI statistics (p < 0.01).ConclusionsLow circulating levels of RA were associated with increased risk of all-cause and CVD mortality in a cohort of patients with first-incidence AIS, indicating that RA level could be a predictor independent of established conventional risk factors.

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Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179348 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9348

Author(s):

Juan F. Sánchez Muñoz-Torrero ◽

Guillermo Escudero-Sánchez ◽

Julián F. Calderón-García ◽

Sergio Rico-Martín ◽

Nicolás Roberto Robles ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Lower Risk ◽

Multivariable Analysis ◽

Large Artery ◽

Risk Of Mortality ◽

Cardiovascular Morbidity And Mortality ◽

Artery Disease ◽

Ischemic Events

Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.

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RESEACH ON THE EXERCISE TESTING COMPARE TO THE RESULT OF CORONARYGRAPHY IN PATIENTS WITH CHEST PAIN

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.2.7 ◽

2012 ◽

pp. 51-57

Author(s):

Thanh Chung Mang ◽

Thi Bich Thuan Le

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

Chest Pain ◽

Systolic Blood Pressure ◽

Coronary Disease ◽

Exercise Testing ◽

Serum Lipid ◽

Lipid Disorder ◽

Significant Difference

Objective and Materials: The research was conducted on 60 patients with chest pain (average age: 56.67 ± 9.28, oldest is 79 and youngest is 36). Patients were applied exercise testing for orient diagnose coronary disease, especially for assessment the sensitivity and the specific of ST/R rate in diagnosing cardiac muscle local ischemia and to compare with the result of coronarygraphy. Results: There were 17 patients with possitive exercise testing result (28.3%) and possitive exercise testing result (71.7%). The risk factors of patients with chest pain took 88.3%, in which serum lipid disorder was 76.7%, hypertension was 60.0%, obesity (48.3%), smoking (40.0%) and diabetes (23.3%). There was no statistic significant difference between coronarygraphy(-) and coronarygraphy(+), p>0.05. There was statistic significant difference about heart rate parameters, exercise capacity, double multiply (HRxTA), HR recovery and systolic blood pressure between two groups of specific chest pain and nonspecific chest pain, p<0.05. There was statistic significant difference between the index of exercise testing and coronarygraphy result, p<0.05. Exercise testing by bicycle in diagnosing coronary disease has the sensitivity, the specific, the accuracy, positive forecast value and negative forecast value was 59.09%, 89.47%, 78.33%, 76.47%, 79.07%, respectively. The R wave in diagnosing coronary disease has the sensitivity, the specific, the accuracy, positive forecast value and negative forecast value was 77.27%, 23.68%, 43.33%, 36.96%, 64.29%, respectively. The rate ST/R in diagnosing coronary disease has the sensitivity, the specific, the accuracy, positive forecast value and negative forecast value was 50.00%, 94.74%, 78.33%, 84.62%, 76.60%, respectively.

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Longitudinal change in blood pressure is associated with cardiovascular disease mortality in a Chinese cohort

Heart ◽

10.1136/heartjnl-2017-312850 ◽

2018 ◽

Vol 104 (21) ◽

pp. 1764-1771 ◽

Cited By ~ 10

Author(s):

Jin-Hu Fan ◽

Jian-Bing Wang ◽

Shao-Ming Wang ◽

Christian C Abnet ◽

You-Lin Qiao ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

General Population ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Longitudinal Change ◽

Stroke Mortality ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

BackgroundA number of studies have demonstrated a J-shaped curve between blood pressure (BP) and all-cause mortality, but few studies have used longitudinal change in BP to study mortality in the Chinese population.MethodsWe performed a 30-year follow-up study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in the Linxian General Population Trial Cohort. At baseline, a total of 29 584 healthy adults were enrolled in the Linxian General Population Trial in 1985 and followed through to the end of 2014. The final analysis was restricted to 29 439 participants (55% women) after exclusion of outliers. We also examined the potential effects of BP trajectory patterns during the period of 1985–1999 on sequent risk of mortality. Adjusted Cox proportional hazards models were used to estimate HRs and 95% CIs.ResultsCompared with participants with normal BP, patients with prehypertension, stage 1, stage 2 or stage 3 hypertension had an increased risk of all-cause mortality, with HRs of 1.09 (95% CI 1.05 to 1.14), 1.34 (95% CI 1.28 to 1.40), 1.69 (95% CI 1.60 to 1.79) and 2.14 (95% CI 2.01 to 2.28), respectively. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular disease and stroke mortality (total: HRs 1.22 (95% CI 1.12 to 1.34) and 1.36 (95% CI 1.23 to 1.51); cardiovascular disease: HRs 1.42 (95% CI 1.17 to 1.73) and 1.55 (95% CI 1.24 to 1.93); stroke: HRs 2.29 (95% CI 1.88 to 2.80) and 2.61 (95% CI 2.11 to 3.24), respectively).ConclusionsThese findings emphasise that development of incident hypertension in middle age could increase the risk of total, cardiovascular disease and stroke mortality, and suggest that current BP targets could be revised.Trial registration numberNCT00342654;Post-results.

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Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure

Blood ◽

10.1182/blood-2011-05-349621 ◽

2012 ◽

Vol 119 (16) ◽

pp. 3684-3690 ◽

Cited By ~ 123

Author(s):

Michael R. DeBaun ◽

Sharada A. Sarnaik ◽

Mark J. Rodeghier ◽

Caterina P. Minniti ◽

Thomas H. Howard ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Hemoglobin Concentration ◽

Multivariable Logistic Regression Analysis ◽

High Systolic Blood Pressure ◽

Increased Risk ◽

Baseline Hemoglobin

Abstract The most common form of neurologic injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial, we sought to identify risk factors associated with SCI. In this cross-sectional study, we evaluated the clinical history and baseline laboratory values and performed magnetic resonance imaging of the brain in participants with SCA (HbSS or HbSβ° thalassemia) between the ages of 5 and 15 years with no history of overt stroke or seizures. Neuroradiology and neurology committees adjudicated the presence of SCI. SCIs were diagnosed in 30.8% (251 of 814) participants who completed all evaluations and had valid data on all prespecified demographic and clinical covariates. The mean age of the participants was 9.1 years, with 413 males (50.7%). In a multivariable logistic regression analysis, lower baseline hemoglobin concentration (P < .001), higher baseline systolic blood pressure (P = .018), and male sex (P = .030) were statistically significantly associated with an increased risk of an SCI. Hemoglobin concentration and systolic blood pressure are risk factors for SCI in children with SCA and may be therapeutic targets for decreasing the risk of SCI. This study is registered at www.clinicaltrials.gov as #NCT00072761.

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Combined lack of blood pressure and lipid control is a major risk factor for mortality in hypertensive patients: a single-center study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2743 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Magkas ◽

G Georgiopoulos ◽

D Konstantinidis ◽

E Manta ◽

M Kouremeti ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Baseline Risk ◽

Effective Control ◽

Hypertensive Patients ◽

Increased Risk ◽

All Cause Mortality ◽

Lipid Control ◽

The Impact

Abstract Background Hypertension and dyslipidemia are well-known risk factors for cardiovascular disease (CVD). In such patients, lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) and targeting to values below pre-specified cut-offs prevents CV events and improves prognosis. However, the impact of both BP and LDL-C control as compared to control of only one and/or none of these two risk factors is not well-studied. Methods Among 2,380 treated patients with hypertension and no overt CVD at baseline, we assessed the trajectory of BP control in 1,142 subjects with 4 or more follow up visits; BP control was defined as BP<140/90 mmHg in half or more visits. In the same subgroup, data on lipid control according to LDL-C goals were available in 1,032 patients in 2 or 3 visits. The HeartScore was used to estimate the risk of all-cause death at baseline. Results Across a median follow up of 108 months, 26 deaths (2.44%) were recorded. Despite appropriate anti-hypertensive treatment, 376 patients (32.92%) did not achieve conventional BP control in half or more of follow-up visits. Respectively, 59.83% of the study population did not meet the LDL-C goals in at least one assessment. Patients with suboptimal BP control had almost 3-fold increased risk for all-cause mortality (HR=2.85, 95% CI 1.31–6.21, P=0.008) as compared to subjects with effective control. This association was not attenuated after taking into account age, gender, body mass index, smoking, and diabetes mellitus (adjusted HR=2.54, 95% CI 1.13–5.72, P=0.025). Ineffective LDL-C control was not related to death (HR=1.31, 95% CI 0.688–2.48). However, patients who did not reach treatment goals for both BP and LDL showed substantially increased risk for all-cause mortality (HR=5.42, 95% CI 1.09–26.9, P=0.039). Importantly, suboptimal BP control in our cohort of hypertensive patients was associated with death independently of the HeartScore (adjusted HR=2.65, 95% CI 1.22–5.77, P=0.014) and conferred incremental reclassification value on top of the baseline risk (continuous NRI=0.467, P=0.016). Conclusions Suboptimal BP control was related to all-cause mortality in our cohort of hypertensive patients; importantly, this association was substantially stronger in concurrent presence of LDL-C values above treatment targets, thus, highlighting the need for combined achievement of BP and LDL-C control. Moreover, association of suboptimal BP controlwith death was independent of the HeartScore, suggesting that BP control should be considered in risk stratification of hypertensive patients Funding Acknowledgement Type of funding source: None

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Factors Associated with Cause-Specific Death in Russia. Data from Longitudinal Prospective Study 1977-2001

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-1-4-16 ◽

2019 ◽

Vol 15 (1) ◽

pp. 4-16 ◽

Cited By ~ 2

Author(s):

S. A. Shalnova ◽

A. V. Kapustina ◽

A. D. Deev ◽

Yu. A. Balanova

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

High Blood Pressure ◽

Total Cholesterol Level ◽

Common Factor ◽

Mortality Rates ◽

Factors Associated ◽

Increased Risk ◽

All Cause Mortality ◽

Related Mortality

Aim.To evaluate the associations between main risk factors (RF) with cause-specific death in cohorts of Russian men and women.Material and methods. Data of a number of crossectional studies conducted in different years by unified base protocol had become the subjects for the study. A total of 12,497 men and 5,039 women aged 35-74 years, residents of Moscow and S-Petersburg (former Leningrad) cities at the moment of examination, were enrolled into the study. We analyzed 17 previously selected risk factors and their associations with cause-specific mortalities: coronary heart disease (CHD), stroke, cardiovascular diseases (CVD), non-CVD, all causes. A total of 10,650 deaths were registered: 8,726 in men (for 10 years) and 1,924 – in women (for 20 years).Results.Men died more often from all the examined causes except for stroke, what was more typical to women. Mortality in men was associated with significantly larger number of RF than in women and correlations were stronger. In particular, smoking (hazard ratio [HR] 2.25; 95% confidence interval [95%CI] 1.75-2.89; р=0.0001), high blood pressure (HR 1.78; 95%CI 1.43-2.22; р=0.0001) and history of CHD (HR 3.23; 95%CI 2.71- 3.84; р=0.0001) significantly increased CHD-related mortality in the men’s cohort but were much less significant for women. The total cholesterol level demonstrated significance in men but was not even selected in the model for women. The main RF for stroke-related mortality were smoking, high blood pressure and atrial fibrillation, while for non-cardiovascular mortality there was only one common factor – smoking. Factors associated with CVD and all-cause mortality were almost the same because CVD cover more than half in the all-cause mortality, however a larger number of predictors were reported in men.Conclusion. The data obtained indicate: 1) considerably larger number of unfavorable risk factors in the men’s cohort, which significantly increased risk for death from any cause; 2) statistically more pronounced relation between risk factors and mortality rates in men as compared to women, especially note that mortality rates were followed up for 10 years in men and 20 years in women. It is obvious that successful prevention focused on risk factors must be gender-based.

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Abstract P210: Risk Factors for Intraparenchymal Hemorrhage Subtypes: The Circulatory Risk in Communities Study (CIRCS)

Circulation ◽

10.1161/circ.127.suppl_12.ap210 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Tetsuya Ohira ◽

Eri Eguchi ◽

Hironori Imano ◽

Akihiko Kitamura ◽

Masahiko Kiyama ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Total Cholesterol ◽

Ethanol Intake ◽

Serum Total Cholesterol ◽

Intraparenchymal Hemorrhage ◽

Effective Prevention ◽

Cholesterol Levels ◽

Increased Risk

Background: To evaluate risk factors for intraparenchymal hemorrhage (IPH) by its subtypes may contribute to more effective prevention of IPH, but few prospective studies have characterized risk factors for specific subtypes of IPH. Hypothesis: We assessed the hypothesis that the associations between traditional risk factors such as blood pressures and risk of IPH vary by IPH subtype. Methods: A prospective study of Japanese subjects aged 40-69 years was undertaken using the data collected from 9,086 participants (3,560 men and 5,526 women) in cardiovascular risk surveys of three communities between 1985 and 1994. The incidence of IPH between 1985 and 2008 was ascertained by systematic surveillance. The location of hemorrhage was assigned based on admission CT scan or MRI by trained physicians. IPH selectively involving the thalamus, basal ganglia or brainstem was defined as deep IPH, while IPH isolated to the cortex was defined as lobar. The hazard ratios (HRs) of incidence of IPH and its subtypes (deep IPH and lobar or cerebellar IPH) and 95% confidence intervals (CI) relative to the baseline variables were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model. Results: During an average follow up of 19.2-years, 139 incident IPHs (103 deep, 31 lobar or cerebellar, and 5 mixed or unclassified IPHs) occurred. Systolic blood pressure, major ST-T abnormality on electrocardiogram, and excess ethanol intake (≥46g/day) were associated with increased risk of deep IPH, while serum total cholesterol levels was inversely associated with incidence of lobar and cerebellar IPH, even after adjustment for potential confounding variables. Serum total cholesterol levels also tended to be inversely associated with incidence of deep IPH, although it did not reach statistically significance. The multivariate-adjusted HRs (95%CI) of deep IPH were 1.14 (1.05-1.23) for systolic blood pressure (10mmHg), 2.09 (1.19- 3.66) for major ST-T abnormality, and 1.86 (1.02- 3.38) for excess ethanol intake. The adjusted HR (95%CI) of lobar and cerebellar IPH was 0.22 (0.07- 0.76) for the participants with higher total cholesterol levels (≥220 mg/dL), compared with those with lower total cholesterol levels (<160mg/dL). There were no associations of diabetes mellitus and smoking with both deep and lobar/cerebellar IPH. Conclusions: Impact of risk factors on incidence of IPH varied according to its subtype.

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