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Impact of Diastolic and Systolic Blood Pressure on Mortality: Implications for the Definition of “Normal”

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ABSTRACT

BACKGROUND

The National Heart, Lung and Blood Institute currently defines a blood pressure under 120/80 as “normal.”

OBJECTIVE

To examine the independent effects of diastolic (DBP) and systolic blood pressure (SBP) on mortality and to estimate the number of Americans affected by accounting for these effects in the definition of “normal.”

DESIGN, PARTICIPANTS AND MEASURES

Data on adults (age 25–75) collected in the early 1970s in the first National Health and Nutrition Examination Survey were linked to vital status data through 1992 (N = 13,792) to model the relationship between blood pressure and mortality rate adjusting for age, sex, race, smoking status, BMI, cholesterol, education and income. To estimate the number of Americans in each blood pressure category, nationally representative data collected in the early 1960s (as a proxy for the underlying distribution of untreated blood pressure) were combined with 2008 population estimates from the US Census.

RESULTS

The mortality rate for individuals over age 50 began to increase in a stepwise fashion with increasing DBP levels of over 90. However, adjusting for SBP made the relationship disappear. For individuals over 50, the mortality rate began to significantly increase at a SBP ≥140 independent of DBP. In individuals ≤50 years of age, the situation was reversed; DBP was the more important predictor of mortality. Using these data to redefine a normal blood pressure as one that does not confer an increased mortality risk would reduce the number of American adults currently labeled as abnormal by about 100 million.

CONCLUSIONS

DBP provides relatively little independent mortality risk information in adults over 50, but is an important predictor of mortality in younger adults. Conversely, SBP is more important in older adults than in younger adults. Accounting for these relationships in the definition of normal would avoid unnecessarily labeling millions of Americans as abnormal.

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ACKNOWLEDGEMENTS

This material received no direct funding, but is the result of work supported with resources and the use of facilities at the Minneapolis and White River Junction VA Medical Centers. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA

    Brent C. Taylor PhD, MPH & Timothy J. Wilt MD, MPH

  2. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Brent C. Taylor PhD, MPH & Timothy J. Wilt MD, MPH

  3. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

    Brent C. Taylor PhD, MPH

  4. VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA

    H. Gilbert Welch MD, MPH

  5. Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH, USA

    H. Gilbert Welch MD, MPH

Authors
  1. Brent C. Taylor PhD, MPH
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  2. Timothy J. Wilt MD, MPH
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  3. H. Gilbert Welch MD, MPH
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Correspondence to Brent C. Taylor PhD, MPH.

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Taylor, B.C., Wilt, T.J. & Welch, H.G. Impact of Diastolic and Systolic Blood Pressure on Mortality: Implications for the Definition of “Normal”. J GEN INTERN MED 26, 685–690 (2011). https://doi.org/10.1007/s11606-011-1660-6

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  • DOI: https://doi.org/10.1007/s11606-011-1660-6

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