CLINICAL STUDIES
A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men
Athanase Benetos, MD, PhD*  ,
Mahmoud Zureik, MD, PhD ,
Jeff Morcet, BSc*,
Frédérique Thomas, PhD*,
Kathryn Bean, MA, MPH*,
Michel Safar, MD,
Pierre Ducimetière, PhD and
Louis Guize, MD*
* Centre d’Investigations Préventives et Cliniques (IPC), Paris, France
INSERM U337, Paris, France
INSERM U258, Villejuif, France
Manuscript received May 3, 1999;
revised manuscript received September 26, 1999,
accepted November 10, 1999.
Reprint requests and correspondence: Dr. Athanase Benetos, Centre d’Investigations Préventives et Cliniques (IPC), 6-14 rue de la Perouse, 75116 Paris, France
OBJECTIVES
The study evaluated the risk of cardiovascular mortality according to combined spontaneous (non-treatment-related) changes in both systolic and diastolic blood pressure (BP).
BACKGROUND
Long-term longitudinal changes in blood pressure may be a more accurate determinant of cardiovascular risk since changes in systolic or diastolic blood pressure over a period of time reflect the evolution of arterial and arteriolar alterations.
METHODS
Two independent French male cohorts were studied: the IPC cohort (Investigations Préventives et Cliniques) composed of 15,561 men aged 20 to 82 years who had had two visits spaced four to 10 years apart, and the Paris Prospective Study composed of 6,246 men aged 42 to 53 years, examined annually for a period of four years. None of the subjects were taking antihypertensive medication. Annual changes in BP were estimated, and subjects were divided into groups according to the increase, lack of change, or decrease of systolic or diastolic BP. Nine groups were formed by combining the changes of systolic and diastolic BP. Cardiovascular mortality was assessed for a mean period of 13.5 years for the IPC Study and 17 years for the Paris Prospective Study.
RESULTS
In both cohorts, after adjustment for age and major risk factors, the group with an increase in systolic and a decrease in diastolic BP presented the highest relative risk of cardiovascular mortality compared to the group with no changes in either systolic or diastolic BP (relative risk: 2.07 [1.05 to 4.06] in the IPC Study and 2.16 [1.16 to 4.01] in the Paris Prospective Study).
CONCLUSIONS
Assessment of spontaneous changes of BP over a long period of time can contribute to the evaluation of cardiovascular risk. Subjects whose systolic BP increased while their diastolic BP decreased had the highest cardiovascular risk independently of absolute values of BP or other risk factors.
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Abbreviations and Acronyms
| | BMI | = body mass index | | BP | = blood pressure | Dia | = increase in diastolic blood pressure | Dia | = decrease in diastolic blood pressure | Dia | = no change in diastolic blood pressure | | INSEE | = Institute National de Statistiques et d’Etudes Economiques | | INSERM | = National Institute of Health and Medical Research | | IPC | = Investigations Préventives et Cliniques | | Sys | = increase in systolic blood pressure | | Sys | = decrease in systolic blood pressure | | Sys | = no change in systolic blood pressure |
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