A good J-bend dating is viewed involving the diastolic blood pressure level and the chemical consequences, with high likelihood of myocardial infarction, ischemic heart attack, otherwise hemorrhagic coronary arrest in a reduced and high deciles to possess diastolic hypertension ( Profile 3C )
In all boards, approximate positions out of systolic or diastolic (given that appropriate) blood-pressure quantities of interest is indicated over the x-axis. Committee A says the unadjusted portion of participants that have myocardial infarction, ischemic coronary arrest, or hemorrhagic coronary attack (the brand new mixture result) based on forty quantiles out of systolic blood pressure. Committee B shows the latest adjusted portion of professionals to your element lead according to 40 quantiles out of systolic tension, handling to have many years, race or cultural classification, and you will coexisting requirements, regarding model estimate out-of multivariable logistic regression that have covariates held from the function (urban area under the individual-operating-trait [ROC] contour for this design, 0.821; pseudo R 2 = 0.158). Committee C reveals the newest unadjusted percentage of professionals to the composite consequences based on 40 quantiles from diastolic blood pressure level. Panel D suggests the fresh new modified portion of members on the chemical result predicated on forty quantiles out of diastolic tension, handling getting decades, competition otherwise ethnic classification, and coexisting standards (area in ROC curve for this design, 0.821; pseudo R 2 = 0.157).
Stratification of those patterns considering race or cultural group or so you’re able to intercourse presented similar overall performance across the such groups
Quantiles of increasing systolic blood pressure were associated with an increased risk of an adverse outcome ( Figure 3A and 3B ). In Cox regression models comparing participants in the lowest quartile of diastolic blood pressure with those in the middle two quartiles, the unadjusted hazard ratio for the composite outcome was 1.44 (95% confidence interval [CI], 1.41 to 1.48; P<0.001), whereas after adjustment for all covariates, the hazard ratio was 0.90 (95% CI, 0.88 to 0.92; P<0.001). With adjustment for the above covariates but without control for age, the analysis showed that lower diastolic blood pressure was associated with adverse outcomes (hazard ratio, 1.15; 95% CI, 1.13 to 1.18; P<0.001). Stratification of the adjusted models according to race or ethnic group or to sex showed similar results across subgroups (Figs. S6 and S7 in the Supplementary Appendix).
In multivariable Cox regression analysis of the composite outcome, the burden of systolic hypertension (?140 mm Hg) was associated with the composite outcome (hazard ratio per unit increase in z score, 1.18; 95% CI, 1.17 to 1.18; P<0.001). In the same model, the burden of diastolic hypertension (?90 mm Hg) was also independently associated with the composite outcome (hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07; P<0.001). Similar results were obtained with the use of the lower threshold of mm Hg or higher (for systolic blood pressure of ?130: hazard ratio per unit increase in z score, 1.18; 95% CI, 1.17 to 1.19; P<0.001; for diastolic blood pressure of ?80 mm Hg: hazard ratio, 1.08; 95% CI, 1.06 to 1.09; P<0.001). When we used blood pressures from only the baseline period, similar results were seen for both hypertension thresholds. Details are provided in Figure S8 and Tables S1 through S3 in the Supplementary Appendix.
We also constructed models in which continuous blood pressures were used without the introduction of thresholds. Among participants for whom the mean systolic or diastolic blood pressure was above the 75th percentile (avoiding potential nonordinal effects at polish hearts the low-to-normal range of blood pressures), both systolic blood pressure (hazard ratio per unit increase in z score, 1.40; 95% CI, 1.38 to 1.43; P<0.001) and diastolic blood pressure (hazard ratio per unit increase in z score, 1.22; 95% CI, 1.20 to 1.24; P<0.001) predicted outcomes independently (Fig. S8 in the Supplementary Appendix). Similar results were obtained with these predictors for the full cohort (for systolic blood pressure: hazard ratio per unit increase in z score, 1.20; 95% CI, 1.18 to 1.21; P<0.001; for diastolic blood pressure: hazard ratio per unit increase in z score, 1.16; 95% CI, 1.15 to 1.18; P<0.001).