Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events.

Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate the cardiovascular events (CVEs) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear. Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006-2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure, is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006-2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess the CVEs risk of the different duration of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVEs occurrence. Results: We found that when the risk of higher BP on CVEs occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: <120/<80 mmHg, 120-129/<80 mmHg, 130-139/80-89 mmHg and ≥140/≥90 mmHg; this time trend was also occurred across the four different BP groups, with the higher BP group exhibiting the CVEs risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6-3.2% and 0.2-3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up. Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVEs risk of higher BP exposure than baseline BP.