Good J-contour relationship try viewed involving the diastolic blood circulation pressure and composite outcome, with high likelihood of myocardial infarction, ischemic coronary arrest, or hemorrhagic coronary arrest in a minimal and you may high deciles to own diastolic blood pressure level ( Figure 3C )
In most boards, calculate ranking off systolic or diastolic (as suitable) blood-stress levels of notice is actually expressed along side x-axis. Panel A claims the latest unadjusted part of players with myocardial infarction, ischemic heart attack, otherwise hemorrhagic heart attack (new element benefit) considering forty quantiles out-of systolic blood pressure level. Panel B reveals the brand new adjusted portion of users towards composite consequences centered on 40 quantiles regarding systolic tension, dealing with to possess years, race otherwise ethnic group, and you may coexisting criteria, regarding design estimate away from multivariable logistic regression which have covariates held at the setting (city in individual-operating-feature [ROC] bend for this design, 0.821; pseudo R 2 = 0.158). Committee C suggests new unadjusted part of professionals to your substance benefit according to 40 quantiles of diastolic blood pressure levels. Panel D shows brand new modified part of users for the compound benefit considering forty quantiles off diastolic stress, handling to own many years, battle otherwise cultural category, and you may https://datingranking.net/crossdresser-dating/ coexisting criteria (town in ROC contour for this model, 0.821; pseudo Roentgen 2 = 0.157).
Stratification ones patterns centered on competition otherwise cultural class otherwise to intercourse demonstrated equivalent overall performance around the these types of classes
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 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).