Pretreatment blood pressure as a predictor of 21-year mortality

Our objective was to evaluate pretreatment predictors of longevity, particu larly blood pressure, in a large cohort of hypertensive men. During 1974 to 1976, 10,367 male hypertensive veterans (47% black) were identified at scr eening and subsequently characterized in 32 special Veterans Administration (VA) hypertension clinics. Their mean age was 52 years and mean blood pres sure (BP) 154/100 mm Hg. During an average of 21 years of follow-up, 61% di ed. Risk ratios for all-cause mortality as functions of BP and other risk f actors are presented for each variable alone; for each variable controlling for age, race, and BP; and for a multivariate model. We observed that when the entire cohort was divided into deciles by systolic blood pressure (SBP ) and by diastolic blood pressure (DBP), the risk ratios for 21-year mortal ity increased from lowest to highest decile by 178% for SBP and 16% for DBP . When the deciles were computed separately by age group, increases from lo west to highest decile for those less than 40 years of age were 138% for SB P and 263% for DBP. For those over 60 years, the increases were 154% and -1 0%, respectively. Although blacks were younger and had more severe diastoli c hypertension than whites, the risk ratios were similar within each race g roup. Risk patterns for mean arterial pressure and pulse pressure resembled those for SBP but had smaller gradients. Survival curves for BP groups sug gested constant mortality rates during follow-up. Other significant observa tions included decreasing mortality with increasing body mass index and inc reased mortality in the Stroke Belt. We concluded that pretreatment SBP str ongly predicted all-cause mortality during 21-year followup. For the young, both SBP and DBP were strong predictors; for the elderly, only SBF was pre dictive. Am J Hypertens 2000;13:724-733 (C) 2000 American Journal of Hypert ension, Ltd.