Abstract Body: Background: Hypertension (HTN) guidelines recommend averaging up to three blood pressure (BP) measurements. However, it is unclear how to interpret risk for cardiovascular disease (CVD) when only one of the three measurements indicates hypertension.
Hypothesis: A single seated HTN reading will be associated with CVD events and mortality, independent of HTN, based on the average of three measurements.
Methods: Atherosclerosis Risk in Communities (ARIC) is a prospective cohort of adults 45-64 years old, followed for CVD events and mortality. During Visit 1 (1987-1989), participants underwent three consecutive seated BP measurements (after a five-minute rest; each separated by one minute). Our primary exposure was the number (zero to three) of HTN measurements, defined as systolic BP (SBP) >130 mmHg. This analysis excluded adults with CVD at baseline. We determined the number of times systolic HTN was observed overall and in strata of HTN treatment. In addition, we examined the association between number of HTN measurements and outcomes using cumulative incidence plots. We also used multivariable-adjusted Cox proportional hazard models to determine the association of number of systolic HTN measurements or HTN based on the average of the three measurements with CVD and all-cause mortality.
Results: Participants (N=13095) had a mean (SD) age of 54 (6) years old. The sample was 56.2% female and 25.3% Black, with an average SBP of 121 + 18 mm Hg across the three measurements. Of those with HTN from the average of three measurements, 79 (7.9%) had only one HTN measurement and 577 (70.2%) had two HTN measurements (Table 1). A greater number of HTN measurements was associated with higher risk of CVD or mortality (Figure). A single HTN measurement was associated with CVD or mortality risk regardless of HTN based on the mean SBP (Table 2). A count of three HTN measurements was more strongly related to CVD than the average when mutually adjusted. Interactions for treatment status were non-significant across outcomes.
Conclusion: Among this population of middle-aged, community dwelling adults, a single occurrence of systolic BP >130 mmHg was associated with higher risk of CVD or mortality independent of HTN based on the mean SBP. Future work should evaluate whether treatment of adults with a single HTN measurement, but no HTN based on a mean SBP, reduces their risk of CVD.