Cumulative mean arterial pressure and risks of adverse cardiac and cerebrovascular events: a prospective cohort study of 53,813 adults

The association between cumulative mean arterial blood pressure (MAP) and risks of adverse cardiac and cerebrovascular events (CCVEs) has not been characterized. This prospective cohort study included 53,813 participants, free of prior myocardial infarction or stroke in or before 2010 (baseline) from a community-based cohort including 101,510 participants. Cumulative MAP was defined as the summed average MAP for each pair of consecutive examinations multiplied by the time interval with the data from previous surveys (2006– 2007, 2008 to 2009, 2010–2011). Incident adverse CCVEs were ascertained by both the information collection in biennial follow-up surveys (2012–2013, 2014–2015) and surveying each year’s discharge lists from local hospitals and death certificates from state vital statistics offices by three experienced physicians blinded to the study design. The study population were stratified into quartiles based on cumulative MAP (<354.62 mmHg, n = 13,454; 354.62 to 392.82 mmHg, n = 13,452; 392.82 to 438.04 mmHg, n = 13 453; ≥ 438.04 mmHg, n = 13,454). We documented 1055 incident adverse CCVEs, including 271 myocardial infarction and 794 stroke (10 comorbid with myocardial infarction), which consisted of 673 ischemic stroke and 134 hemorrhagic stroke (13 comorbid with ischemic stroke). The incidence of adverse CCVEs increased with the increase of cumulative MAP with significant difference (p < 0.001). Cox proportional hazards regression models revealed the elevated cumulative MAP as an independent risk factor for adverse CCVEs, especially hemorrhagic stroke, after adjusting potential confounders. A J-shaped relationship between cumulative MAP and hemorrhagic stroke was also observed.