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Article review: Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk. The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project

Article review: Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk. The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project
  • Cardiometabolic
  • Hypertension

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Article

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Article review
stroke risk
Systolic blood pressure
diastolic blood pressure
MORGAM project

Article review by Brian Tomlinson, Professor of Medicine and Therapeutics, The Chinese University of Hong Kong

This article presents an analysis of the age-related effects of baseline systolic (SBP) and diastolic blood pressure (DBP) on fatal and nonfatal stroke from a total of 68,551 participants aged 19 to 78 years without cardiovascular disease at baseline and followed up for a mean of 13.2 years from 34 cohorts in 10 European countries in the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. In the last one to two decades there has been a shift in the paradigm to consider SBP rather than DBP as the more important target for blood pressure treatment.  This analysis re-examines that concept using a large European data set.  The findings are somewhat complex but can be summarized by saying that the relationship between DBP and stroke showed a J-curve with the lowest risk for stroke at 71 mmHg. Below this there was an inverse relationship between DBP and the risk of stroke, which became significant with increasing age from 50 years and above, whereas at levels of DBP above 71 mmHg the relationship was positive and significant in younger subjects up to age 62 years.  Stroke risk was associated positively with SBP at all ages.  Considering increasing values of DBP 71 mmHg, this showed the greatest risk in the youngest subjects and was a greater risk than SBP up to age 46 years, above which SBP became the more important risk.

Pulse pressure was also significantly associated with stroke risk independent of the mean arterial pressure (MAP) and age, but pulse pressure did not appear to be superior to SBP for association with stroke risk in the elderly.  The association of MAP with stroke risk was greatest in the youngest ages and became non-significant after the age of about 70 years.

Will these findings affect clinical practice?  No, not at this stage but this may come as a timely reminder for clinicians not to completely ignore high DBP levels in young patients up to the age of about 60 and to be cautious about excessive lowering of DBP in older patients with isolated systolic hypertension and starting DBP <70 mmHg.  Furthermore, this is an observational study which is restricted to European subjects and which only examines the risk for stroke. There is a higher risk of stroke than coronary disease in East Asian countries and the proportion of haemorrhagic strokes is higher and it is not known whether these findings would apply in other populations. A subsequent analysis will examine the relationships with cardiac outcomes, which will help to provide the full picture.

 

Article resource

Impact of Age on the Importance of Systolic and Diastolic Blood Pressures for Stroke Risk. The MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project.Vishram JK, Borglykke A, Andreasen AH, et al. Hypertension. 2012;60:1117-1123.

(Editorial commentary: Making good use of diastolic and systolic blood pressures in the management of hypertension. Chalmers J. Hypertension 2012;60:1110-1.)

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