Good J-contour dating try viewed amongst the diastolic blood circulation pressure and also the substance lead, with high danger of myocardial infarction, ischemic stroke, or hemorrhagic stroke in both a reduced and you may large deciles getting diastolic blood pressure levels ( Contour 3C )
In most panels, calculate positions out-of systolic otherwise diastolic (once the appropriate) blood-tension quantities of attract are indicated over the x-axis. Panel A shows the unadjusted percentage of professionals having myocardial infarction, ischemic heart attack, otherwise hemorrhagic stroke (the fresh new mixture lead) predicated on 40 quantiles away from systolic blood pressure. Panel B shows this new adjusted part of users with the composite outcome according to forty quantiles away from systolic stress, controlling to own age, battle or cultural category, and coexisting conditions, from design estimation out-of multivariable logistic regression which have covariates stored in the mode (urban area within the individual-operating-trait [ROC] curve for it design, 0.821; pseudo R dos = 0.158). Committee C reveals brand new unadjusted part of players into the mixture result predicated on forty quantiles regarding diastolic blood pressure level. Panel D suggests the newest adjusted percentage of people into composite benefit considering 40 quantiles off diastolic tension, controlling getting ages, battle or cultural category, and you will coexisting criteria (urban area https://datingranking.net/nl/eris-overzicht/ beneath the ROC contour for it model, 0.821; pseudo Roentgen 2 = 0.157).
Stratification of those models centered on competition or ethnic classification otherwise to sex presented comparable results across 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).