Blood pressure and cardiovascular disease in the Asia... : Journal of Hypertension (original) (raw)

Original papers: Epidemiology

Sponsorship: The Asia Pacific cohort Studies Collaboration has been supported by grants from the Health Research Council of New Zealand and National Health and the Medical Research Council of Australia.

Conflicts of interest: None.

See editorial commentary page 673

Correspondence to Asia Pacific Cohort Studies Collaboration, Clinical Trials Research Unit, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64-9 3737 599 Ext. 4716; fax: +64-9 373 1710; e-mail: [email protected]

Received 6 September 2002 Revised 29 December 2002 Accepted 7 January 2003

Abstract

Objectives

To estimate age-, sex- and region-specific associations of blood pressure with cardiovascular diseases.

Design

Relative risk estimates and 95% confidence intervals were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk on individual participant data from 37 cohort studies. Repeat measurements of blood pressure were used to adjust for regression dilution bias.

Setting

Studies included in the Asia Pacific Cohort Studies Collaboration from Australia, mainland China, Hong Kong, Japan, New Zealand, Singapore, South Korea, and Taiwan.

Participants

A total of 425 325 study participants.

Main outcomes measures

Stroke, ischaemic heart disease, total cardiovascular death.

Results

During over 3 million person-years of follow-up, 5178 strokes, 3047 ischaemic heart disease events and 6899 cardiovascular deaths were observed. Continuous log-linear associations were seen between systolic blood pressure and the risks of all three endpoints down to at least 115 mmHg. In the age groups < 60, 60–69, and ≥ 70 years, a 10 mmHg lower usual systolic blood pressure was associated with 54% (95% CI 53–56%), 36% (34–38%) and 25% (22–28%) lower stroke risk, and 46% (43–49%), 24% (21–28%) and 16% (13–20%) lower ischaemic heart disease risk, respectively. All associations were similar in men and women. Blood pressure was at least as strongly associated with cardiovascular events in Asian populations compared to Australasian populations.

Conclusions

About half of the world's cardiovascular burden is predicted to occur in the Asia Pacific region. Blood pressure is an important determinant of this burden, with considerable potential benefit of blood pressure lowering down to levels of at least 115 mmHg systolic blood pressure.