Cumulative BP exposure a better predictor of CV outcomes, mortality

Cumulative blood pressure (BP) exposure over the previous 10 years results in improved prediction of incident cardiovascular events and mortality beyond that derived from a single value, according to a study.

Data were obtained from a large community database and used to examine the incremental value of 10-year cumulative BP exposure over standard risk based on a single value using the Pooled Cohort Equations (PCE). The index data was 1 January 2018, with a 5-year prediction horizon and 10 years of prior exposure.

Individuals aged ≥45 years who had no known cardiovascular disease (CVD) and had at least three prior BP values were included.

Cumulative BP over the previous 10 years, the primary exposure, was expressed as the area under the systolic BP curve over 140 mm Hg. The authors assessed the ability of the model to improve prediction of “Hard CVD” (ie, cardiac mortality, myocardial infarction, or stroke), stroke, and all-cause mortality above that achieved by the PCE.

A total of 614,084 individuals were identified and divided into a derivation set (n=428,826) and a validation set (n=184,222).

The C statistic improved by 0.8 percent (95 percent confidence interval [CI], 0‒0.8) for “Hard CVD”, 1.3 percent (95 percent CI, 1.0‒1.7) for stroke, and 0 percent (95 percent CI, 0‒0.1) for all-cause mortality outcomes. Continuous net reclassification also improved by 0.492, 0.656, and 0.539, respectively.

“Introduction of cumulative BP exposure into electronic health records might facilitate personalized risk prediction,” the authors said.