Optimal combinations of systolic and diastolic blood pressure in Korea: A nationwide population-based cohort study

Won Jun Choi; Hye Sun Lee; Jung Hwa Hong; Hyuk Jae Chang; Ji Won Lee

doi:10.1111/jch.14125

Optimal combinations of systolic and diastolic blood pressure in Korea: A nationwide population-based cohort study

Won Jun Choi, Hye Sun Lee, Jung Hwa Hong, Hyuk Jae Chang, Ji Won Lee

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

We investigated the optimal combinations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels for lowest mortality in participants not taking hypertensive medication at the study baseline using nationwide representative databases. Survival rates and hazard ratios (HRs) were calculated using Kaplan-Meier curves and multivariable Cox regression analyses. The discriminatory ability for clinical outcomes was assessed by Harrell's C-index analysis. A survival spline curve was presented, and Classification and Regression Tree (CART) analysis was performed. SBP ≥ 140 group and DBP ≥ 90 group had the highest risk of mortality. Within SBP < 120, the HR (95% CIs) for all-cause mortality (ACM) was the lowest for DBP 70-79. Within SBP 120-139, the HR (95% CIs) for ACM was significantly lower for DBP 70-79. Within SBP ≥ 140, the HR (95% CIs) for ACM was significantly lower for DBP 80-89. Conversely, within SBP ≥ 140, DBP < 70 showed the highest risk for ACM. Similar relationships were observed when survival spline curves and CART analysis were used. The combination of SBP and DBP discriminated better than SBP or DBP alone for mortality. The effect of DBP on mortality varies according to the SBP range. It is more effective to evaluate the effect of SBP and DBP jointly for clinical outcomes.

Original language	English
Pages (from-to)	85-95
Number of pages	11
Journal	Journal of Clinical Hypertension
Volume	23
Issue number	1
DOIs	https://doi.org/10.1111/jch.14125
Publication status	Published - 2021 Jan

Bibliographical note

Funding Information:
This work was supported by the Bio and Medical Technology Development Program (NRF‐2018R1D1A1B07049223) through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (MSIP, Korea); and the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea).

Funding Information:
Ji‐Won Lee has received two grants from the Bio and Medical Technology Development Program (NRF‐2018R1D1A1B07049223) through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (Korea); and the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea). For the remaining authors no other support sources were declared.

Publisher Copyright:
© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC

All Science Journal Classification (ASJC) codes

Internal Medicine
Endocrinology, Diabetes and Metabolism
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/jch.14125

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title = "Optimal combinations of systolic and diastolic blood pressure in Korea: A nationwide population-based cohort study",

abstract = "We investigated the optimal combinations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels for lowest mortality in participants not taking hypertensive medication at the study baseline using nationwide representative databases. Survival rates and hazard ratios (HRs) were calculated using Kaplan-Meier curves and multivariable Cox regression analyses. The discriminatory ability for clinical outcomes was assessed by Harrell's C-index analysis. A survival spline curve was presented, and Classification and Regression Tree (CART) analysis was performed. SBP ≥ 140 group and DBP ≥ 90 group had the highest risk of mortality. Within SBP < 120, the HR (95% CIs) for all-cause mortality (ACM) was the lowest for DBP 70-79. Within SBP 120-139, the HR (95% CIs) for ACM was significantly lower for DBP 70-79. Within SBP ≥ 140, the HR (95% CIs) for ACM was significantly lower for DBP 80-89. Conversely, within SBP ≥ 140, DBP < 70 showed the highest risk for ACM. Similar relationships were observed when survival spline curves and CART analysis were used. The combination of SBP and DBP discriminated better than SBP or DBP alone for mortality. The effect of DBP on mortality varies according to the SBP range. It is more effective to evaluate the effect of SBP and DBP jointly for clinical outcomes.",

author = "Choi, {Won Jun} and Lee, {Hye Sun} and Hong, {Jung Hwa} and Chang, {Hyuk Jae} and Lee, {Ji Won}",

note = "Funding Information: This work was supported by the Bio and Medical Technology Development Program (NRF‐2018R1D1A1B07049223) through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (MSIP, Korea); and the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea). Funding Information: Ji‐Won Lee has received two grants from the Bio and Medical Technology Development Program (NRF‐2018R1D1A1B07049223) through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (Korea); and the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea). For the remaining authors no other support sources were declared. Publisher Copyright: {\textcopyright} 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC",

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N2 - We investigated the optimal combinations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels for lowest mortality in participants not taking hypertensive medication at the study baseline using nationwide representative databases. Survival rates and hazard ratios (HRs) were calculated using Kaplan-Meier curves and multivariable Cox regression analyses. The discriminatory ability for clinical outcomes was assessed by Harrell's C-index analysis. A survival spline curve was presented, and Classification and Regression Tree (CART) analysis was performed. SBP ≥ 140 group and DBP ≥ 90 group had the highest risk of mortality. Within SBP < 120, the HR (95% CIs) for all-cause mortality (ACM) was the lowest for DBP 70-79. Within SBP 120-139, the HR (95% CIs) for ACM was significantly lower for DBP 70-79. Within SBP ≥ 140, the HR (95% CIs) for ACM was significantly lower for DBP 80-89. Conversely, within SBP ≥ 140, DBP < 70 showed the highest risk for ACM. Similar relationships were observed when survival spline curves and CART analysis were used. The combination of SBP and DBP discriminated better than SBP or DBP alone for mortality. The effect of DBP on mortality varies according to the SBP range. It is more effective to evaluate the effect of SBP and DBP jointly for clinical outcomes.

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Optimal combinations of systolic and diastolic blood pressure in Korea: A nationwide population-based cohort study

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

UN SDGs

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