Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Feb 22:342:d643.
doi: 10.1136/bmj.d643.

Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts

Johan Sundström  1 , Martin Neovius, Per Tynelius, Finn Rasmussen
Affiliations

Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts

Johan Sundström et al. BMJ. .

Abstract

Objective: To investigate the nature and magnitude of relations of systolic and diastolic blood pressures in late adolescence to mortality.

Design: Nationwide cohort study.

Setting: General community in Sweden.

Participants: Swedish men (n = 1,207,141) who had military conscription examinations between 1969 and 1995 at a mean age of 18.4 years, followed up for a median of 24 (range 0-37) years.

Main outcome measures: Total mortality, cardiovascular mortality, and non-cardiovascular mortality.

Results: During follow-up, 28,934 (2.4%) men died. The relation of systolic blood pressure to total mortality was U shaped, with the lowest risk at a systolic blood pressure of about 130 mm Hg. This pattern was driven by the relation to non-cardiovascular mortality, whereas the relation to cardiovascular mortality was monotonically increasing (higher risk with higher blood pressure). The relation of diastolic blood pressure to mortality risk was monotonically increasing and stronger than that of systolic blood pressure, in terms of both relative risk and population attributable fraction (deaths that could be avoided if blood pressure was in the optimal range). Relations to cardiovascular and non-cardiovascular mortality were similar, with an apparent risk threshold at a diastolic blood pressure of about 90 mm Hg, below which diastolic blood pressure and mortality were unrelated, and above which risk increased steeply with higher diastolic blood pressures.

Conclusions: In adolescent men, the relation of diastolic blood pressure to mortality was more consistent than that of systolic blood pressure. Considering current efforts for earlier detection and prevention of risk, these observations emphasise the risk associated with high diastolic blood pressure in young adulthood.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) the authors have no support from any company for the submitted work; (2) the authors have no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) the authors have no non-financial interests that may be relevant to the submitted work.

Figures

None
Fig 1 Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to total risk of death. Solid line represents hazard of total mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
None
Fig 2  Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to cardiovascular mortality. Solid line represents hazard of cardiovascular mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
None
Fig 3  Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to non-cardiovascular mortality. Solid line represents hazard of non-cardiovascular mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
None
Fig 4  Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to cancer mortality. Solid line represents hazard of non-cardiovascular mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
None
Fig 5  Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to risk of death from suicide. Solid line represents hazard of non-cardiovascular mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
None
Fig 6  Relations of systolic (top left), diastolic (top right), mean arterial (bottom left), and pulse (bottom right) pressures to risk of death from other external causes. Solid line represents hazard of non-cardiovascular mortality and dashed lines are 95% confidence interval limits, from multivariable regression spline Cox proportional hazards C models (adjusted for age, conscription date, conscription centre, socioeconomic position, body mass index, elbow flexion, hand grip, and knee extension strength). Y scale is logarithmic
See this image and copyright information in PMC

Comment in

References

    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747-57. - PubMed
    1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23. - PubMed
    1. Franklin SS, Gustin W IV, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic patterns of age-related changes in blood pressure: the Framingham Heart Study. Circulation 1997;96:308-15. - PubMed
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13. - PubMed
    1. Williams B, Lindholm LH, Sever P. Systolic pressure is all that matters. Lancet 2008;371:2219-21. - PubMed

Publication types

LinkOut - more resources