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Relationship of Blood Pressure to 25-Year Mortality Due to Coronary Heart Disease, Cardiovascular Diseases, and All Causes in Young Adult Men
The Chicago Heart Association Detection Project in Industry
Katsuyuki Miura, MD, PhD;
Martha L. Daviglus, MD, PhD;
Alan R. Dyer, PhD;
Kiang Liu, PhD;
Daniel B. Garside, MA;
Jeremiah Stamler, MD;
Philip Greenland, MD
Arch Intern Med. 2001;161:1501-1508.
Background Data are limited on blood pressure (BP) in young adults and long-term
mortality. Moreover, screening and hypertension treatment guidelines have
been based mainly on findings for middle-aged and older populations. This
study assesses relationships of BP measured in young adult men to long-term
mortality due to coronary heart disease (CHD), cardiovascular diseases (CVD),
and all causes.
Methods This cohort from the Chicago Heart Association Detection Project in
Industry included 10 874 men aged 18 to 39 years at baseline (1967-1973),
not receiving antihypertensive drugs, and without CHD or diabetes. Relationship
of baseline BP to 25-year CHD, CVD, and all-cause mortality was assessed.
Results Age-adjusted association of systolic BP to CHD mortality was continuous
and graded. Multivariate-adjusted CHD hazard ratios (HRs) for 1 SD higher
systolic BP (15 mm Hg) and diastolic BP (10 mm Hg) were 1.26 (95% confidence
interval [CI], 1.11-1.44) and 1.17 (95% CI, 1.01-1.35), respectively. Compared
with the Sixth Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure stratum with normal BP (and
lowest mortality rates), the large strata with high-normal BP and stage 1
hypertension had 25-year absolute risks for death of 63 and 72 per 1000, respectively,
and absolute excess risks of 10 and 20 per 1000, respectively; accounted for
59.8% of all excess CHD, CVD, and all-cause mortality; and were estimated
to have life expectancy shortened by 2.2 and 4.1 years, respectively.
Conclusions In young adult men, BP above normal was significantly related to increased
long-term mortality due to CHD, CVD, and all causes. Population-wide primary
prevention, early detection, and control of higher BP are indicated from young
adulthood on.
From the Department of Preventive Medicine, Northwestern University
Medical School, Chicago, Ill (Drs Miura, Daviglus, Dyer, Liu, Stamler, and
Greenland and Mr Garside), and the Department of Public Health, Kanazawa Medical
University, Ishikawa, Japan (Dr Miura).
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