Good J-bend relationship are seen between your diastolic hypertension plus the substance outcome, with high risk of myocardial infarction, ischemic coronary arrest, otherwise hemorrhagic coronary attack both in a decreased and you may high deciles for diastolic blood pressure level ( Contour 3C )
In most panels, approximate positions away from systolic otherwise diastolic (because the compatible) blood-pressure amounts of focus is actually shown along side x axis. Panel A states the fresh unadjusted percentage of people which have myocardial infarction, ischemic coronary attack, or hemorrhagic coronary attack (the new substance lead) predicated on 40 quantiles out of systolic blood pressure levels. Committee B shows the adjusted part of users toward chemical benefit according to 40 quantiles of systolic pressure, handling to possess age, battle or ethnic class, and coexisting criteria, away from model quote from multivariable logistic regression that have covariates held in the function (city according to the person-operating-trait [ROC] bend because of it model, 0.821; pseudo chemistryprofielen Roentgen 2 = 0.158). Panel C suggests the fresh unadjusted portion of players on the compound benefit predicated on forty quantiles from diastolic blood pressure level. Committee D suggests the latest modified percentage of professionals towards substance outcome predicated on forty quantiles regarding diastolic stress, dealing with for ages, race or cultural group, and you can coexisting conditions (town under the ROC bend because of it model, 0.821; pseudo R 2 = 0.157).
Stratification ones designs according to battle otherwise cultural group or so you can gender exhibited similar results around the this type of groups
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).