Association between blood pressure multi-trajectory and cardiovascular disease among a Chinese elderly medical examination population

Abstract

Objective: This study aimed to characterize multivariate trajectories of blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)] jointly and examine their impact on incident cardiovascular disease (CVD) among a Chinese elderly medical examination population.

Methods: A total of 13,504 individuals without CVD during 2018-2020 were included from the Chinese geriatric physical examination cohort study. The group-based trajectory model was used to construct multi-trajectories of systolic blood pressure and diastolic blood pressure. The primary outcome was the incidence of the first CVD events, consisting of stroke and coronary heart diseases, in 2021. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between BP multi-trajectories and incident CVD events.

Results: We identified four blood pressure (BP) subclasses, summarized by their SBP and DBP levels from low to high as class 1 (7.16%), class 2 (55.17%), class 3 (32.26%), and class 4 (5.41%). In 2021, we documented 890 incident CVD events. Compared with participants in class 1, adjusted HRs were 1.56 (95% CI: 1.12-2.19) for class 2, 1.75 (95% CI: 1.24-2.47) for class 3, and 1.88 (95% CI: 1.24-2.85) for class 4 after adjustment for demographics, health behaviors, and metabolic index. Individuals aged 65 years and above with higher levels of BP trajectories had higher risks of CVD events in China.

Conclusions: Individuals with higher levels of both SBP and DBP trajectories over time were associated with an increased risk of incident CVD in the Chinese elderly population.

Keywords: blood pressure; cardiovascular disease; elderly population; group-based trajectory model; multivariate trajectory.

Figure 1

Flowchart of inclusion of participants.

Figure 2

Predicted trajectories of four systolic blood pressure value classes among elderly Chinese adults, Nanjing Regional Health Information Platform Based on Health records 2018–2020 (N = 13,504). The Y-axis indicates the systolic blood pressure value. The X-axis indicates the year.

Figure 3

Predicted trajectories of four diastolic blood pressure value classes among elderly Chinese adults, Nanjing Regional Health Information Platform Based on Health Records 2018–2020 (N = 13,504). The Y-axis indicates the diastolic blood pressure value. The X-axis indicates the year.

Figure 4

HRs and 95% CIs for CVD by multivariate trajectories of blood pressure in older adults in China, 2018–2020 (N = 13,504). Estimates are weighted using the sampling weight. Model 1: unadjusted. Model 2: adjusted for baseline sex and education. Model 3: model 2 further adjusted for drinking status. Model 4: model 3 further adjusted for BMI, WC, FPG, and HDL-C.