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The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group.
N Engl J Med. 2000 Jan 06; 342(1):1-8.NEJM

Abstract

BACKGROUND

Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in relation to blood pressure varies among populations.

METHODS

In six populations in different parts of the world, we examined systolic and diastolic blood pressures and hypertension in relation to long-term mortality from CHD, both with and without adjustment for variability in blood pressure within individual subjects. Blood pressure was measured at base-line in 12,031 men (age range, 40 to 59 years) who were free of CHD. During 25 years of follow-up, 1291 men died from CHD.

RESULTS

At systolic and diastolic blood pressures of about 140 and 85 mm Hg, respectively, 25-year rates of mortality from CHD (standardized for age) varied by a factor of more than three among the populations. Rates in the United States and northern Europe were high (approximately 70 deaths per 10,000 person-years), but rates in Japan and Mediterranean southern Europe were low (approximately 20 deaths per 10,000 person-years). However, the relative increase in 25-year mortality from CHD for a given increase in blood pressure was similar among the populations. The overall unadjusted relative risk of death due to CHD was 1.17 (95 percent confidence interval, 1.14 to 1.20) per 10 mm Hg increase in systolic pressure and 1.13 (95 percent confidence interval, 1.10 to 1.15) per 5 mm Hg increase in diastolic pressure, and it was 1.28 for each of these increments after adjustment for within-subject variability in blood pressure.

CONCLUSIONS

Among the six populations we studied, the relative increase in long-term mortality due to CHD for a given increase in blood pressure is similar, whereas the absolute risk at the same level of blood pressure varies substantially. If the absolute risk of CHD is used as an indication for antihypertensive therapy, these findings will have major implications for treatment in different parts of the world.

Authors+Show Affiliations

Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

10620642

Citation

van den Hoogen, P C., et al. "The Relation Between Blood Pressure and Mortality Due to Coronary Heart Disease Among Men in Different Parts of the World. Seven Countries Study Research Group." The New England Journal of Medicine, vol. 342, no. 1, 2000, pp. 1-8.
van den Hoogen PC, Feskens EJ, Nagelkerke NJ, et al. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med. 2000;342(1):1-8.
van den Hoogen, P. C., Feskens, E. J., Nagelkerke, N. J., Menotti, A., Nissinen, A., & Kromhout, D. (2000). The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. The New England Journal of Medicine, 342(1), 1-8.
van den Hoogen PC, et al. The Relation Between Blood Pressure and Mortality Due to Coronary Heart Disease Among Men in Different Parts of the World. Seven Countries Study Research Group. N Engl J Med. 2000 Jan 6;342(1):1-8. PubMed PMID: 10620642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. AU - van den Hoogen,P C, AU - Feskens,E J, AU - Nagelkerke,N J, AU - Menotti,A, AU - Nissinen,A, AU - Kromhout,D, PY - 2000/1/6/pubmed PY - 2000/1/6/medline PY - 2000/1/6/entrez SP - 1 EP - 8 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 342 IS - 1 N2 - BACKGROUND: Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in relation to blood pressure varies among populations. METHODS: In six populations in different parts of the world, we examined systolic and diastolic blood pressures and hypertension in relation to long-term mortality from CHD, both with and without adjustment for variability in blood pressure within individual subjects. Blood pressure was measured at base-line in 12,031 men (age range, 40 to 59 years) who were free of CHD. During 25 years of follow-up, 1291 men died from CHD. RESULTS: At systolic and diastolic blood pressures of about 140 and 85 mm Hg, respectively, 25-year rates of mortality from CHD (standardized for age) varied by a factor of more than three among the populations. Rates in the United States and northern Europe were high (approximately 70 deaths per 10,000 person-years), but rates in Japan and Mediterranean southern Europe were low (approximately 20 deaths per 10,000 person-years). However, the relative increase in 25-year mortality from CHD for a given increase in blood pressure was similar among the populations. The overall unadjusted relative risk of death due to CHD was 1.17 (95 percent confidence interval, 1.14 to 1.20) per 10 mm Hg increase in systolic pressure and 1.13 (95 percent confidence interval, 1.10 to 1.15) per 5 mm Hg increase in diastolic pressure, and it was 1.28 for each of these increments after adjustment for within-subject variability in blood pressure. CONCLUSIONS: Among the six populations we studied, the relative increase in long-term mortality due to CHD for a given increase in blood pressure is similar, whereas the absolute risk at the same level of blood pressure varies substantially. If the absolute risk of CHD is used as an indication for antihypertensive therapy, these findings will have major implications for treatment in different parts of the world. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/10620642/The_relation_between_blood_pressure_and_mortality_due_to_coronary_heart_disease_among_men_in_different_parts_of_the_world__Seven_Countries_Study_Research_Group_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM200001063420101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -