Examining the Linear Association Between Blood Pressure Levels and Cardiovascular Diseases in the Absence of Major Risk Factors in China

Ruizhi Zheng; Yu Xu; Mian Li; Jieli Lu; Shujing Wu; Jingya Niu; Zhiyun Zhao; Li Chen; Yanan Huo; Min Xu; Tiange Wang; Shuangyuan Wang; Hong Lin; Guijun Qin; Li Yan; Qin Wan; Lulu Chen; Lixin Shi; Ruying Hu; Xulei Tang; Qing Su; Xuefeng Yu; Yingfen Qin; Gang Chen; Zhengnan Gao; Guixia Wang; Feixia Shen; Zuojie Luo; Yuhong Chen; Yinfei Zhang; Chao Liu; Youmin Wang; Shengli Wu; Tao Yang; Qiang Li; Yiming Mu; Jiajun Zhao; Weiqing Wang; Guang Ning; Yufang Bi; 4C Study Group†

doi:10.1161/CIRCOUTCOMES.121.008774

Examining the Linear Association Between Blood Pressure Levels and Cardiovascular Diseases in the Absence of Major Risk Factors in China

Circ Cardiovasc Qual Outcomes. 2022 Sep;15(9):e008774. doi: 10.1161/CIRCOUTCOMES.121.008774. Epub 2022 Sep 6.

Authors

Ruizhi Zheng^#^{1

2}, Yu Xu^#^{1

2}, Mian Li¹, Jieli Lu^{1

2}, Shujing Wu^{1

2}, Jingya Niu^{1

2}, Zhiyun Zhao^{1

2}, Li Chen³, Yanan Huo⁴, Min Xu^{1

2}, Tiange Wang^{1

2}, Shuangyuan Wang^{1

2}, Hong Lin^{1

2}, Guijun Qin⁵, Li Yan⁶, Qin Wan⁷, Lulu Chen⁸, Lixin Shi⁹, Ruying Hu¹⁰, Xulei Tang¹¹, Qing Su¹², Xuefeng Yu¹³, Yingfen Qin¹⁴, Gang Chen¹⁵, Zhengnan Gao¹⁶, Guixia Wang¹⁷, Feixia Shen¹⁸, Zuojie Luo¹⁴, Yuhong Chen^{1

2}, Yinfei Zhang¹⁹, Chao Liu²⁰, Youmin Wang²¹, Shengli Wu²², Tao Yang²³, Qiang Li²⁴, Yiming Mu²⁵, Jiajun Zhao²⁶, Weiqing Wang^{1

2}, Guang Ning^{1

2}, Yufang Bi^{1

2}; 4C Study Group†

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China.
³ Qilu Hospital of Shandong University, Jinan, China (Li Chen).
⁴ Jiangxi Provincial People's Hospital Affiliated to Nanchang University, China (Y.H.).
⁵ The First Affiliated Hospital of Zhengzhou University, China (G.Q.).
⁶ Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China (L.Y.).
⁷ The Affiliated Hospital of Southwest Medical University, Luzhou, China (Q.W.).
⁸ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Lulu Chen).
⁹ Affiliated Hospital of Guiyang Medical College, China (L.S.).
¹⁰ Zhejiang Provincial Center for Disease Control and Prevention, China (R.H.).
¹¹ The First Hospital of Lanzhou University, China (X.T.).
¹² Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (Q.S.).
¹³ Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.Y.).
¹⁴ The First Affiliated Hospital of Guangxi Medical University, Nanning, China (Y.Q., Z.L.).
¹⁵ Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (G.C.).
¹⁶ Dalian Municipal Central Hospital, China (Z.G.).
¹⁷ The First Hospital of Jilin University, Changchun, China (G.W.).
¹⁸ The First Affiliated Hospital of Wenzhou Medical University, China (F.S.).
¹⁹ Central Hospital of Shanghai Jiading District, China (Y.Z.).
²⁰ Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China (C.L.).
²¹ The First Affiliated Hospital of Anhui Medical University, Hefei, China (Y.W.).
²² Karamay Municipal People's Hospital, Xinjiang, China (Shengli Wu).
²³ The First Affiliated Hospital of Nanjing Medical University, China (T.Y.).
²⁴ The Second Affiliated Hospital of Harbin Medical University, China (Q.L.).
²⁵ Chinese People's Liberation Army General Hospital, Beijing (Y.M.).
²⁶ Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China (J.Z.).

^# Contributed equally.

PMID: 36065814
DOI: 10.1161/CIRCOUTCOMES.121.008774

Abstract

Background: Many studies demonstrate a J-shaped association between blood pressure and cardiovascular diseases (CVDs), but the findings are plagued by confounding from other traditional cardiovascular risk factors (CVRFs). Our aims were to examine the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with CVD in individuals without major CVRFs and whether there were thresholds for the association.

Methods: In the 4C study (China Cardiometabolic Disease and Cancer Cohort), 36 042 CVRF-free participants without CVD, diabetes, dyslipidemia, hypertension, or smoking were identified during 2011 to 2012. Among CVRF-free participants, 17 476 CVRF-preferable individuals with better glycemic (fasting glucose, <110 mg/dL; 2-hour post-load glucose, <140 mg/dL) and lipid profile (total cholesterol, <200 mg/dL; LDL [low-density lipoprotein] cholesterol, <130 mg/dL) were selected. The total person-years of follow-up for CVRF-free subjects and CVRF-preferable subjects were 130 147 and 63 573 person-years, respectively. Information on the development of major CVDs was collected during 2014 to 2016. Cox proportional hazard models were performed to estimate the risks for incident CVD by SBP and DBP groups, respectively.

Results: We found that both baseline SBP and DBP presented significantly linear associations with CVD risks in CVRF-free and CVRF-preferable participants. There is significant increase in the CVD risk among CVRF-free participants with baseline SBP level of 110 to 119 mm Hg (hazard ratio, 1.79 [95% CI, 1.19-2.71]), 120 to 129 mm Hg (hazard ratio, 2.03 [95% CI, 1.36-3.03]), and 130 to 139 mm Hg (hazard ratio, 2.15 [95% CI, 1.40-3.28]) compared with SBP <110 mm Hg. Significant increases were also observed for DBP level of 80 to 89 mm Hg (hazard ratio, 1.43 [95% CI, 1.03-1.97]) compared with DBP <70 mm Hg. Similar results were observed in CVRF-preferable participants.

Conclusions: SBP and DBP with levels currently considered normal were significantly and linearly associated with incident CVD without thresholds above 110/70 mm Hg among Chinese adults without major CVRFs.

Keywords: blood pressure; cardiovascular diseases; cohort study; risk factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Pressure
Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Cholesterol, LDL
Glucose
Humans
Hypertension* / complications
Hypertension* / diagnosis
Hypertension* / epidemiology
Risk Factors

Substances

Cholesterol, LDL
Glucose