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. 2025 Dec;57(1):2476735.
doi: 10.1080/07853890.2025.2476735. Epub 2025 Mar 11.

Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population

Fang-Fei You  1 , Wen-Fang Zhong  1 , Yi-Ning Gao  1 , Zhi-Hao Li  1 , Jian Gao  1   2 , Dong Shen  1 , Jiao-Jiao Ren  1 , Xiao-Meng Wang  1 , Qi Fu  1 , Wei-Qi Song  1 , Chuan Li  1 , Chen Mao  1   3
Affiliations

Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population

Fang-Fei You et al. Ann Med. 2025 Dec.

Abstract

Background: Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old.

Methods: 6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke.

Results: During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05-1.20, HR, 1.14; 95%, 1.07-1.22, HR, 1.14; 95%, 1.07-1.22), heart disease (HR, 1.05; 95%, 0.97-1.13, HR, 1.09; 95%, 1.01-1.17, HR, 1.08; 95%, 1.00-1.16) and stroke (HR, 1.35; 95%, 1.21-1.51, HR, 1.31; 95%, 1.17-1.46, HR, 1.36; 95%, 1.22-1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10-1.38). None nonlinear relationships were identified (p-nonlinear > .05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p < .001).

Conclusions: Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age, whereas cPP was associated with stroke only across all ages. Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement. Efforts are required to control long-term BP in assessing cardiovascular risks.

Keywords: CHARLS; CVD; Cumulative blood pressure; heart disease; stroke.

Plain language summary

We used a large national database and a prospective cohort study.Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age.Long-term cPP was associated with stroke only across all ages.Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Subgroup analyses for association between each SD increment in cumulative blood pressure and risk of incident CVD (left), heart disease (middle) and stroke (right).
Figure 2.
Figure 2.
Dose-Response of Cumulative Blood Pressure and CVD (top), Heart Disease (middle) and Stroke (bottom).
See this image and copyright information in PMC

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