Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk

Abstract

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of X90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4X90 mmHg) or transient hypertensive (both DBP4o90 mmHg) status. Transients (n ¼ 850) were matched with normotensive controls (n ¼ 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n ¼ 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P ¼ 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P ¼ 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR ¼ 5.1, P ¼ 0.04) and stroke (adj OR 15.9, P ¼ 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

Does Blood Pressure Variability Modulate Cardiovascular Risk?

“…There was a borderline statistically significant excess of white matter lesions (WMLs) and cerebral atrophy among those with moderate and high SBP variability, but with only three BP measurements over 6 years, the authors concluded that intermittent high measurements were probably simply a surrogate for more fixed elevations. In a study of patients from UK general practices who had BP measured on three occasions at least 1 month apart in 1974 [62], men who had DBP of 90 mm Hg or higher on the first measurement but not on the second two occasions had a higher risk of stroke on follow-up than matched normotensive controls, but the estimate was based on only eight events, and no effect was seen in women. Day-to-day variability in home BP based on at least 10 readings over 30 days in 2,455 subjects in the Ohasama Study was related to 63 stroke deaths over the next 11 years [63].…”

“…Two small, retrospective case-control studies and a few, mainly small, cohort studies have reported conflicting findings [58][59][60][61][62][63]. Hata et al found that variability in prior office BPs extracted from the case notes was slightly greater in 138 patients with incident stroke than in matched hypertensive controls (coefficient of variation [CV] for SBP=9.7 vs 8.9 mm Hg) [58], but only a difference in CV of DBP was found in a follow-on retrospective case-control study of 139 patients with myocardial infarction [59].…”

Platelet counts are associated with arterial stiffness in Chinese Han population: a longitudinal study

“…Thus, it was likely that elevated DBP found in a routine health examination was only a transient abnormality. Wingfield D et al [ 19 ] demonstrated that transient high DBP could increase both cardiovascular (CVD) mortality and the incidence of diabetes. Given that arterial stiffness is independently predictive of CVD death [ 20 ], transient high DBP may also be associated with arterial stiffness.…”

Effects of e‐cigarettes and vaping devices on cardiac and pulmonary physiology

“…Systolic blood pressure (SBP) was not significantly increased after e‐cigarette use, although differences were found in diastolic blood pressure (DBP) across studies, and elevations in DBP are associated with increased cardiovascular disease risk and mortality, particularly in women (Wingfield et al . 2005). Vlachopoulos et al .…”