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Low Systolic Blood Pressure and Vascular Mortality Among More Than 1 Million Korean Adults

 Sang-Wook Yi  ;  Yejin Mok  ;  Heechoul Ohrr  ;  Jee-Jeon Yi  ;  Young Duk Yun  ;  Jihwan Park  ;  Sun Ha Jee 
 CIRCULATION, Vol.133(24) : 2381-2490, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Follow-Up Studies ; Humans ; Hypotension/mortality* ; Hypotension/physiopathology ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Systole ; Treatment Outcome ; Vascular Diseases/mortality* ; Vascular Diseases/physiopathology
blood pressure ; cohort studies ; hypotension ; mortality ; vascular diseases
BACKGROUND: The association between low systolic blood pressure (SBP) and vascular disease is unclear, especially in nonclinical populations. METHODS AND RESULTS: We studied 1?235?246 individuals who participated in routine medical examinations between 1992 and 1995. The hazard ratios (HRs) were adjusted for potential confounders. During 22.7 million person-years of follow-up, 34?816 individuals died of atherosclerotic vascular diseases. An increase in SBP was directly related to an increase in vascular mortality at SBP above ?100 mmHg. The group with the lowest SBP (<90 mm?Hg) had a higher HR for mortality from atherosclerotic vascular disease (HR, 1.53; 95% confidence interval, 1.15-2.03) in comparison with those with an SBP of 90 to 99 mm?Hg. The HR associated with the lowest SBP was 2.54 (95% confidence interval, 1.51-4.29) for ischemic heart disease and 1.21 (95% confidence interval, 0.79-1.85) for stroke. Regarding stroke subtype, mortality from hemorrhagic stroke (HR per 10 mm?Hg increase, 0.53; 95% confidence interval, 0.29-0.96), rather than mortality from ischemic stroke (HR per 10 mm?Hg increase, 1.00; 95% confidence interval, 0.51-1.97), was inversely associated with SBP when SBP fell to <100 mm?Hg. Even when excluding the first 5 years of follow-up, the HRs associated with the lowest SBP did not decrease. The inverse association between SBP and vascular mortality in the range <100 mm?Hg tended to be apparent in people aged 60 to 95 years in comparison with individuals aged 30 to 59 years. CONCLUSIONS: J-curve associations exist between SBP and vascular mortality, which reach a nadir at ?100 mm?Hg. SBP of <90 mm?Hg may portend death from vascular disease, particularly from ischemic heart disease.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Ohrr, Hee Choul(오희철)
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
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