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Measured Blood Pressure, Genetically Predicted Blood Pressure, and Cardiovascular Disease Risk in the UK Biobank

Authors
 So Mi Jemma Cho  ;  Satoshi Koyama  ;  Yunfeng Ruan  ;  Kim Lannery  ;  Megan Wong  ;  Ezimamaka Ajufo  ;  Hokyou Lee  ;  Amit V Khera  ;  Michael C Honigberg  ;  Pradeep Natarajan 
Citation
 JAMA CARDIOLOGY, Vol.7(11) : 1129-1137, 2022-11 
Journal Title
JAMA CARDIOLOGY
ISSN
 2380-6583 
Issue Date
2022-11
Keywords
Antihypertensive Agents / therapeutic use ; Biological Specimen Banks ; Blood Pressure / physiology ; Cardiovascular Diseases* / complications ; Cardiovascular Diseases* / epidemiology ; Cardiovascular Diseases* / genetics ; Cohort Studies ; Female ; Heart Failure* / drug therapy ; Humans ; Hypertension* / drug therapy ; Hypertension* / epidemiology ; Hypertension* / genetics ; Myocardial Infarction* / drug therapy ; Stroke* / complications ; Stroke* / epidemiology ; Stroke* / genetics ; United Kingdom / epidemiology
Abstract
Importance: Hypertension remains the major cardiovascular disease risk factor globally, but variability in measured blood pressure may result in suboptimal management. Whether genetic contributors to elevated blood pressure may complementarily inform cardiovascular disease risk assessment is unknown.

Objective: To examine incident cardiovascular disease by blood pressure polygenic risk score independent of measured blood pressures and antihypertensive medication prescriptions.

Design, setting, and participants: The cohort study (UK Biobank) recruited UK residents aged 40 to 69 years between March 2006 and August 2010. Participants without a prior physician diagnosis of cardiovascular disease, including myocardial infarction, stroke, or heart failure, were included. Excluded were individuals with mismatch between self-reported and genotypically inferred sex, sex aneuploidy, missing genotype rates of 1% or greater, and excess genotypic heterozygosity. Data analyses were performed from September 25, 2021, to July 21, 2022.

Exposures: Measured blood pressure and externally derived blood pressure polygenic risk score stratified by hypertension diagnosis and management, which included normal blood pressure (<130/80 mm Hg without antihypertensives), untreated hypertension (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg without antihypertensives), and treated hypertension (current antihypertensives prescriptions).

Main outcomes and measures: Composite of first incident myocardial infarction, stroke, heart failure, or cardiovascular-related death.

Results: Of the 331 078 study participants included (mean [SD] age at enrollment, 56.9 [8.1] years; 178 824 female [54.0%]), 83 094 (25.1%) had normal blood pressure, 197 597 (59.7%) had untreated hypertension, and 50 387 (15.2%) had treated hypertension. Over a median (IQR) follow-up of 11.1 (10.4-11.8) years, the primary outcome occurred in 15 293 participants. Among those with normal blood pressure, untreated hypertension, and treated hypertension, each SD increase in measured systolic blood pressure was associated with hazard ratios of 1.08 (95% CI, 0.93-1.25), 1.20 (95% CI, 1.16-1.23), and 1.16 (95% CI, 1.11-1.20), respectively, for the primary outcome. Among these same categories, each SD increase in genetically predicted systolic blood pressure was associated with increased hazard ratios of 1.13 (95% CI, 1.05-1.20), 1.04 (95% CI, 1.01-1.07), and 1.06 (95% CI, 1.02-1.10), respectively, for the primary outcome independent of measured blood pressures and other covariates. Findings were similar for measured and genetically predicted diastolic blood pressure.

Conclusions and relevance: Blood pressure polygenic risk score may augment identification of individuals at heightened cardiovascular risk, including those with both normal blood pressure and hypertension. Whether it may also guide antihypertensive initiation or intensification requires further study.
Full Text
https://jamanetwork.com/journals/jamacardiology/fullarticle/2796903
DOI
10.1001/jamacardio.2022.3191
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Hokyou(이호규) ORCID logo https://orcid.org/0000-0002-5034-8422
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/193897
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