Does the Relation of Blood Pressure to Coronary Heart Disease Risk Change With Aging?

TLDR

Coronary heart disease risk is influenced by blood pressure components, but the relative importance of diastolic, systolic, and pulse pressure across age groups is unclear. This study aimed to determine which blood pressure index best predicts CHD risk in different age strata of the Framingham Heart Study cohort. Using 3060 men and 3479 women aged 20–79 without baseline CHD or antihypertensive treatment, the authors applied Cox regression adjusted for age, sex, and other risk factors to assess BP index associations over 20 years. Results showed that diastolic pressure was the strongest predictor in those under 50, all three indices were comparable between 50–59, and pulse pressure became the dominant predictor after 60, with systolic pressure directly and diastolic inversely related to risk in the oldest group.

Abstract

Background —We examined the relative importance of diastolic (DBP), systolic (SBP) and pulse pressure (PP) as predictors of coronary heart disease (CHD) risk in different age groups of Framingham Heart Study participants. Methods and Results —We studied 3060 men and 3479 women between 20 and 79 years of age who were free of CHD and were not on antihypertensive drug therapy at baseline. Cox regression adjusted for age, sex, and other risk factors was used to assess the relations of BP indexes to CHD risk over a 20-year follow-up. In the group <50 years of age, DBP was the strongest predictor of CHD risk (hazard ratio [HR] per 10 mm Hg increment, 1.34; 95% CI, 1.18 to 1.51) rather than SBP (HR, 1.14; 95% CI, 1.06 to 1.24) or PP (HR, 1.02; 95% CI, 0.89 to 1.17). In the group 50 to 59 years of age, risks were comparable for all 3 BP indexes. In the older age group, the strongest predictor of CHD risk was PP (HR, 1.24; 95% CI, 1.16 to 1.33). When both SBP and DBP were considered jointly, the former was directly and the latter was inversely related to CHD risk in the oldest age group Conclusions —With increasing age, there was a gradual shift from DBP to SBP and then to PP as predictors of CHD risk. In patients <50 years of age, DBP was the strongest predictor. Age 50 to 59 years was a transition period when all 3 BP indexes were comparable predictors, and from 60 years of age on, DBP was negatively related to CHD risk so that PP became superior to SBP.