The J-curve between diastolic blood pressure and risk of all-cause and cardiovascular death

Heejin Kimm, Ye Jin Mok, Sun Ju Lee, Sunmi Lee, Joung Hwan Back, Sun Ha Jee

Research output: Contribution to journalArticle

Abstract

Background and Objectives: The J-curve phenomenon between diastolic blood pressure (DBP) and mortality has been reported repeatedly in treated patients. However, the baseline risk of low DBP has not been fully explored. This study was to examine the relationship between DBP and risk of mortality from all-cause, atherosclerotic vascular diseases (ASCVD), and ischemic heart disease (IHD) using a prospective cohort of general population. Methods: We analyzed 1,234,435 participants of the Korean Cancer Prevention Study cohort (789,255 men, 30-95 years of age) who had a medical evaluation from 1992 to 1995 using Cox proportional hazards models. Results: A total of 22.5 million person-years were followed up (mean age 46.6 years, deaths 193,903 cases). The hazard ratios of mortality from all-cause and ASCVD, among those with DBP <60 mmHg compared to 70-79 mmHg were 1.23 (95% confidence interval [CI], 1.16-1.30) and 1.37 (95% CI, 1.20-1.57), respectively, after adjustment for multivariable including systolic blood pressure. Increased risks of all-cause death in the lowest DBP category group were maintained in men or women, 30-59 or ≥60 years of age, smoker or non-smoker and diabetes mellitus (DM) or non-DM subgroups. The risk in DBP 60-69 mmHg groups increased in several subgroups. However, the risk for ASCVD death in 30-59 years and DM group, and risk for IHD death in most subgroups except for elderly (≥60 years) decreased. Conclusion: A J-curve relationship between low DBP and all-cause death was found consistently. The baseline risk in the general population may be considered for risk assessment, particularly in case of interventions that lower DBP below 60 mmHg.

Original languageEnglish (US)
Pages (from-to)36-47
Number of pages12
JournalKorean Circulation Journal
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Cause of Death
Blood Pressure
Vascular Diseases
Hypotension
Myocardial Ischemia
Mortality
Diabetes Mellitus
Confidence Intervals
Proportional Hazards Models
Population
Cohort Studies

Keywords

  • Blood pressure
  • Diastolic blood pressure
  • Hypertension
  • Mortality
  • Myocardial ischemia

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

The J-curve between diastolic blood pressure and risk of all-cause and cardiovascular death. / Kimm, Heejin; Mok, Ye Jin; Lee, Sun Ju; Lee, Sunmi; Back, Joung Hwan; Jee, Sun Ha.

In: Korean Circulation Journal, Vol. 48, No. 1, 01.01.2018, p. 36-47.

Research output: Contribution to journalArticle

Kimm, Heejin ; Mok, Ye Jin ; Lee, Sun Ju ; Lee, Sunmi ; Back, Joung Hwan ; Jee, Sun Ha. / The J-curve between diastolic blood pressure and risk of all-cause and cardiovascular death. In: Korean Circulation Journal. 2018 ; Vol. 48, No. 1. pp. 36-47.
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AB - Background and Objectives: The J-curve phenomenon between diastolic blood pressure (DBP) and mortality has been reported repeatedly in treated patients. However, the baseline risk of low DBP has not been fully explored. This study was to examine the relationship between DBP and risk of mortality from all-cause, atherosclerotic vascular diseases (ASCVD), and ischemic heart disease (IHD) using a prospective cohort of general population. Methods: We analyzed 1,234,435 participants of the Korean Cancer Prevention Study cohort (789,255 men, 30-95 years of age) who had a medical evaluation from 1992 to 1995 using Cox proportional hazards models. Results: A total of 22.5 million person-years were followed up (mean age 46.6 years, deaths 193,903 cases). The hazard ratios of mortality from all-cause and ASCVD, among those with DBP <60 mmHg compared to 70-79 mmHg were 1.23 (95% confidence interval [CI], 1.16-1.30) and 1.37 (95% CI, 1.20-1.57), respectively, after adjustment for multivariable including systolic blood pressure. Increased risks of all-cause death in the lowest DBP category group were maintained in men or women, 30-59 or ≥60 years of age, smoker or non-smoker and diabetes mellitus (DM) or non-DM subgroups. The risk in DBP 60-69 mmHg groups increased in several subgroups. However, the risk for ASCVD death in 30-59 years and DM group, and risk for IHD death in most subgroups except for elderly (≥60 years) decreased. Conclusion: A J-curve relationship between low DBP and all-cause death was found consistently. The baseline risk in the general population may be considered for risk assessment, particularly in case of interventions that lower DBP below 60 mmHg.

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