TY - JOUR
T1 - Multi-state analysis of hypertension and mortality
T2 - Application of semi-Markov model in a longitudinal cohort study
AU - Ramezankhani, Azra
AU - Blaha, Michael J.
AU - Mirbolouk, Mohammad Hassan
AU - Azizi, Fereidoun
AU - Hadaegh, Farzad
N1 - Funding Information:
This study was conducted in the framework of the Tehran Lipid and Glucose Study (TLGS) and was supported by the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences. We express our appreciation to TLGS participants and the research team members for their contribution to the study.
Funding Information:
This study was supported by grant No. 121 from the National Research Council of the Islamic Republic of Iran. This funding source had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/6
Y1 - 2020/7/6
N2 - Background: Most previous research has studied the association of hypertension with cardiovascular disease (CVD) and all-cause mortality by focusing on the transition from the initial state to a single outcome. We investigated the impact of hypertension, defined according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) (new) and the Seventh Report of the Joint National Committee (JNC7) (old), on CVD death and all-cause mortality considering non-fatal CVD as an intermediate event between two CVD-free and mortality states. Methods: A total of 3002 Iranian population (47.4% men), aged ≥50 years were followed from 1999 to 2014. Two multi-state semi-Markov models with three transitions were defined for CVD death and all-cause mortality as two outcomes. The multivariable Cox model was used to estimate the effect of hypertension on transition hazards. The mean of 15-year life expectancy of participants in each transition was estimated using the restricted mean survival time. Results: The ACC/AHA guideline increased the prevalence of hypertension from 43.3 to 68.6%. Among CVD-free individuals, hypertension was significantly associated with increased risk of non-fatal CVD [Hazard Ratio, 1.52 (1.28-1.81) and 1.48 (1.21-1.80)], CVD death [2.96 (2.06-4.25) and 1.98 (1.30-3.04)] and all-cause mortality [1.64 (1.32-2.05) and 1.31 (1.01-1.69)] according the old and new guidelines, respectively. However, after incident non-fatal CVD, the association between hypertension and mortality events was not significant according to both definitions. Hypertensive participants experienced a first non-fatal CVD about 0.9 and 0.6 years earlier than normotensive population according to JNC7 and the 2017 ACC/AHA guidelines, respectively. Conclusion: Hypertension, according to JNC7 and the ACC/AHA guidelines, significantly increased the risk of mortality events among CVD-free population although the risk was attenuated using ACC/AHA guideline. Hypertension also decreased the number of years lived without CVD and early onset of CVD, and consequently, an increase in the time spent with these diseases. After non-fatal CVD, hypertension had no significant impact on mortality risk according to both guidelines.
AB - Background: Most previous research has studied the association of hypertension with cardiovascular disease (CVD) and all-cause mortality by focusing on the transition from the initial state to a single outcome. We investigated the impact of hypertension, defined according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) (new) and the Seventh Report of the Joint National Committee (JNC7) (old), on CVD death and all-cause mortality considering non-fatal CVD as an intermediate event between two CVD-free and mortality states. Methods: A total of 3002 Iranian population (47.4% men), aged ≥50 years were followed from 1999 to 2014. Two multi-state semi-Markov models with three transitions were defined for CVD death and all-cause mortality as two outcomes. The multivariable Cox model was used to estimate the effect of hypertension on transition hazards. The mean of 15-year life expectancy of participants in each transition was estimated using the restricted mean survival time. Results: The ACC/AHA guideline increased the prevalence of hypertension from 43.3 to 68.6%. Among CVD-free individuals, hypertension was significantly associated with increased risk of non-fatal CVD [Hazard Ratio, 1.52 (1.28-1.81) and 1.48 (1.21-1.80)], CVD death [2.96 (2.06-4.25) and 1.98 (1.30-3.04)] and all-cause mortality [1.64 (1.32-2.05) and 1.31 (1.01-1.69)] according the old and new guidelines, respectively. However, after incident non-fatal CVD, the association between hypertension and mortality events was not significant according to both definitions. Hypertensive participants experienced a first non-fatal CVD about 0.9 and 0.6 years earlier than normotensive population according to JNC7 and the 2017 ACC/AHA guidelines, respectively. Conclusion: Hypertension, according to JNC7 and the ACC/AHA guidelines, significantly increased the risk of mortality events among CVD-free population although the risk was attenuated using ACC/AHA guideline. Hypertension also decreased the number of years lived without CVD and early onset of CVD, and consequently, an increase in the time spent with these diseases. After non-fatal CVD, hypertension had no significant impact on mortality risk according to both guidelines.
KW - Cardiovascular
KW - Guideline
KW - Hypertension
KW - Mortality
KW - Multi-state
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U2 - 10.1186/s12872-020-01599-7
DO - 10.1186/s12872-020-01599-7
M3 - Article
C2 - 32631245
AN - SCOPUS:85087731363
SN - 1471-2261
VL - 20
JO - BMC Cardiovascular Disorders
JF - BMC Cardiovascular Disorders
IS - 1
M1 - 321
ER -