| Part one Association of Systolic Blood Pressure Levels with Non-fatal Cardiovascular and Cerebrovascular Events and All-cause Mortality in kailuan Chinese.Objective: We aimed to examine the impact of different levels of systolic blood pressure(SBP)on the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death in kailuan Chinese.Methods: A total of 97,013 Chinese men and women from Kailuan study were followed up with the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death.According to the different blood pressure,the subjects were divided into three groups: normotensive group,isolated systolic hypertension,systolic and diastolic hypertension.The non-fatal cardiovascular events and all-cause mortality were observed.The participants were categorized into 9 groups based on the different SBP levels(group1-9):SBP<110 mmHg,110 mmHg? SBP<120 mmHg,120 mmHg? SBP<130mmHg,130 mmHg? SBP<140 mmHg,140 mmHg? SBP<150 mmHg,150mmHg? SBP<160 mmHg,160 mmHg? SBP<170 mmHg,170 mmHg?SBP<180 mmHg,SBP?180 mmHg.Hazard ratios(HRs)with 95% confidence intervals(CIs)were calculated from Cox regression models.There are two models: model 1 and model 2.Attributable risk(AR)and AR%,Population attributable risk(PAR)and PAR% were calculated.According to the prevalence of hypertension into the cohort a total of 42173 people,four groups were followed by <5 years,5 years ? time <10 years,10 years ? time <15years,time ? 15 years,non-fatal cardiovascular and cerebrovascular events Rates were observed.Results: During a mean follow-up of 4.02 years,a total of 2043 non-fatalcardiovascular and cerebrovascular events and 1686 of all-cause deaths occurred.Study cohort 57470 cases of normal blood pressure,8533 cases of isolated systolic hypertension,23,544 cases of systolic and diastolic hypertension.The incidences of non-fatal cardiovascular and cerebrovascular events in three groups were 1.14%,3.77% and 3.97% respectively,and the incidence of all-cause death was 1.24%,3.32% and 2.59% respectively.Compared with normal blood pressure group,Each group had higher rates(P<0.001).With the increase of systolic blood pressure,the incidence of non-fatal cardiovascular and cerebrovascular events,myocardial infarction,cerebral infarction,cerebral hemorrhage and all-cause mortality in Kailuan population increased gradually.After adjustmenting for age and sex and using group 1 as reference,Model 1 found that HRs of non-fatal cardiovascular and cerebrovascular events(95% CIs)for group 2 to 9 were 1.49(1.11-2.00)?1.85(1.41-2.44)? 1.84(1.40-2.43)? 2.63(2.00-3.46)? 3.27(2.48-4.32)?4.22(3.19-5.57)? 5.56(4.12-7.49)? 6.52(4.89-8.68),HRs(95% CIs)of all-cause death were 0.95(0.74-1.23)? 0.97(0.77-1.22)? 1.05(0.83-1.32)?1.22(0.97-1.54)? 1.16(0.91-1.48)? 1.44(1.12-1.84)? 1.78(1.34-2.37)?2.12(1.63-2.75).Model 2 is based on model 1,correcting for triglycerides,total cholesterol,smoking,drinking,history of hypertension and diabetes mellitus.HRs of non-fatal cardiovascular and cerebrovascular events(95%CIs)for group 2 to 9 were 1.35(1.00-1.82),1.61(1.22-2.12),1.54(1.16-2.04),2.05(1.55-2.72),2.47(1.86-3.29),3.04(2.28-4.06),3.93(2.89-5.36),and 4.56(3.39-6.15),respectively.HRs(95% CIs)of all-cause death for group 2 to 9were 0.92(0.71-1.20),0.95(0.75-1.20),1.06(0.83-1.34),1.18(0.93-1.50),1.16(0.90-1.49),1.39(1.07-1.81),1.74(1.29-2.33),and 2.06(1.56-2.72),respectively.Compared with SBP <110mmHg group,the AR values of non-fatal cardiovascular events in groups 2-9 were 0.007,0.019,0.030,0.092,0.180,0.321,-0.002,-0.001 respectively.AR% were 41.133%,58.164%,64.722%,77.957%,83.669%,87.493%,-129.703%,-60.311%.PAR values were 0.002,0.005,0.006,0.011,0.012,0.014,0.011,0.014 respectively.PAR% were 29.047%,48.311%,52.707%,65.874%,68.501%,71.397%,64.709%,71.417% respectively.The AR values for all-cause mortality in Groups 2-9 were 0.001,0.004,0.014,0.033,0.039,0.070,-0.002,-0.002 respectively.AR% was 11.467%,25.755%,45.209%,59.805%,62.147%,70.106%,-138.953%,---respectively.PAR values were 0.001,0.002,0.005,0.007,0.006,0.008,0.006,0.008.PAR% were 7.053%,18.911%,33.389%,44.815%,41.069%,45.556%,38.780%,47.829% respectively.According to the prevalence of hypertension into the cohort a total of 42173 people,four groups were followed by <5 years,5 years ? time <10 years,10 years ?time <15 years,time ? 15 years,non-fatal cardiovascular and cerebrovascular events Rates were 3.23%,3.75%,4.43%,5.2%(P trend<0.001),all causes of death were 2.38%,2.4%,2.73%,3.07%(P=0.1582).Part two Association of diastolic Blood Pressure Levels with Non-fatal Cardiovascular and Cerebrovascular Events and All-cause Mortality in kailuan Chinese.Objective: The aim of this study was to examine the impact of the diastolic blood pressure(DBP)levels on the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death in kailuan Chinese.Methods: A large prospective cohort of Chinese men(n=77241)and women(n=19772)from Kailuan study aged 18 to 98 years(mean age,51.5±12.57 years)who had an annual physical examination between July 2006 and October 2007 were followed up with the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death until the end of2010.According to the different blood pressure,the subjects were divided into three groups: normotensive group,isolated diastolic hypertension,systolic and diastolic hypertension.Participants were divided into 7 groups according to different DBP levels including group 1 with DBP<60 mmHg,group 2 with 60mmHg? DBP<70 mmHg,group 3 with 70 mmHg? DBP<80 mmHg,group 4with 80mmHg? DBP<90 mmHg,group 5 with 90 mmHg? DBP<100 mmHg,group 6 with 100 mmHg? DBP<110 mmHg,and group 7 with DBP?110mmHg.Hazard ratios(HRs)with 95% confidence intervals(CIs)were calculated from Cox regression models.There are two models: model 1 and model 2.Attributable risk(AR)and AR%,Population attributable risk(PAR)and PAR% were calculated.The risk ratio of systolic and diastolic blood pressure to non-fatal cardiovascular events and all-cause mortality was compared.Results: During a follow-up of 4.02 years,a total of 2043 non-fatal cardiovascular and cerebrovascular events including 430 of myocardial infarctions(MI),1204 of ischemic stroke and 449 of hemorrhagic stroke occurred,and 1686 of all-cause death occurred.Study cohort 57470 cases of normal blood pressure,7466 cases of simple diastolic hypertension,systolic and diastolic blood pressure were 23544 cases.The incidences of non-fatal cardiovascular and cerebrovascular events in three groups were 1.14%,1.73%and 3.97% respectively(P<0.001),and the incidence of all-cause death was1.24%,1.10% and 2.59% respectively.In different DBP groups,the incidences of total non-fatal cardiovascular events were 1.24%,0.94%,1.27%,1.71%,2.8%,3.92%,5.7%(P<0.001),the incidence of myocardial infarction were0.25%,0.14%,0.33%,0.4%,0.59%,0.68%,0.82%(P <0.001),the incidence of infarction were 0.62%,0.64%,0.76%,0.98%,1.68%,2.26% and 3.43%respectively(P <0.001),the incidences of intracerebral hemorrhage were0.37%,0.17%,0.2%,0.35%,0.59%,1.1% and 1.58%(P <0.001),the incidence of death were 2.11%,1.44%,1.42%,1.56%,1.91%,2.42%,3.56%(P <0.001).After adjustmenting for age and sex and using group 1 as reference,Model 1 found that HRs of non-fatal cardiovascular and cerebrovascular events(95% CIs)for group 2 to 7 were 0.77(0.39-1.49)?0.92(0.49-1.73)? 1.13(0.61-2.11)? 1.74(0.93-3.25)? 2.52(1.34-4.72)?3.87(2.05-7.33),HRs(95% confidence interval)of all-cause death for group 2to 7 were 0.71(0.42-1.18)?0.61(0.37-0.99)?0.61(0.37-0.98)?0.69(0.42-1.12)?0.91(0.55-1.49)? 1.4(0.84-2.34).Model 2 was based on model 1.After adjustments for potential confounding factors such as age,gender,triglyceride,total cholesterol,smoking,alcohol consumption and history of hypertensionand diabetes,using group 1 as reference,HRs of total cardiovascular and cerebrovascular events(95% confidence interval)for group 2 to 7 were0.75(0.39-1.46)? 0.86(0.46-1.61)? 1.03(0.55-1.92)? 1.56(0.83-2.91)?2.21(1.18-4.16)?3.21(1.69-6.09),HRs(95% confidence interval)of all-cause death for group 2 to 7 were 0.71(0.42-1.19)? 0.63(0.38-1.02)?0.63(0.39-1.02)? 0.72(0.44-1.17)? 0.95(0.58-1.55)? 1.47(0.88-2.46)respectively.Compared with DBP <60mmHg group,the AR values of non-fatal cardiovascular and cerebrovascular events in groups 2-7 were-0.002,0.000,0.006,0.035,0.085,0.205 respectively,AR% were-31.574%,2.623%27.443%,55.737%,68.336%,78.227% respectively,PAR values were-0.003,0.000,0.005,0.015,0.025,0.035 respectively,PAR% were-27.188%,2.532%,27.015%,54.682%,66.547%,73.952 %.The AR values of all-cause mortality in groups 2-7 were-0.005,-0.005,-0.004,-0.002,0.004 and 0.024 respectively,AR% were-45.978%,-48.824%,-35.339%,-10.418%,12.937 %and 40.709% respectively,PAR values were-0.006,-0.007,-0.005,-0.002,0.003 and 0.011 respectively,PAR% were-38.999%,-46.263%,-34.326%,-9.940%,12.046% and 35.172%.The risk ratios of systolic and diastolic blood pressure to non-fatal cardiovascular and cerebrovascular events were compared,with HR values of 1.177 and 1.135.The risk ratios of systolic and diastolic blood pressure to all-cause mortality were 1.109 and 1.011 for HR.Systolic blood pressure was higher than Diastolic pressure.Part three Association of pulse Pressure Levels with Non-fatal Cardiovascular and Cerebrovascular Events and All-cause Mortality in kailuan Chinese.Objective: The purpose of the study was to determine the association of the pulse pressure(PP)levels on the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death in kailuan Chinese.Methods: We performed a prospective cohort study among employees of the Kailuan Group Corporation,who were the first time to take part in the Kailuan physical examination in 2006-2007.A large prospective cohort of Chinese men(n=77241)and women(n=19772)from Kailuan study aged 18 to98 years(mean age,51.5±12.57 years)who had an annual physical examination between July 2006 and October 2007 were followed up with the incidence of cardiovascular and cerebrovascular events and all-cause death until the end of 2010.The incidence of non-fatal cardiovascular and cerebrovascular events and all-cause death were observed.Participants were divided into 8 groups according to different PP levels including group 1 with PP<25mmHg,group 2 with 25 mmHg? PP<35 mmHg,group 3 with 35 mmHg?PP<45 mmHg,group 4 with 45mmHg? PP<55 mmHg,group 5 with 55mmHg? PP<65 mmHg,group 6 with 65 mmHg? PP<75 mmHg,and group 7with 75 mmHg? PP<85 mmHg,group 8 with PP?85 mmHg.Hazard ratios(HRs)with 95% confidence intervals(CIs)were calculated from Cox regression models.Attributable risk(AR)and AR%,Population attributable risk(PAR)and PAR% were calculated.Results: During a follow-up of 4.02 years,a total of 2043 non-fatal cardiovascular and cerebrovascular events including 430 of myocardial infarctions(MI),1204 of ischemic stroke and 449 of hemorrhagic stroke occurred,and 1686 of all-cause death occurred.In different PP groups,the incidence of non-fatal cardiovascular and cerebrovascular event were respectively 1%,0.98%,1.21%,2.01%,3.13%,4.91%,5.58%,8.09%(P<0.001),the incidence of myocardial infarction were 0.15%,0.23%,0.28%,0.39%,0.63%,1.1%,1.07%,1.51%(P <0.001),the incidence of cerebral infarction were 0.54%,0.57%,0.68%,1.18%,1.92%,2.97%,3.13% and5.12% respectively(P <0.001),the incidences of intracerebral hemorrhage were 0.38%,0.2%,0.26%,0.47%,0.66%,0.92%,1.49% and 1.86%(P<0.001),all-cause mortality rates were 0.38%,0.95%,1.09%,1.77%,2.54%,3.13%,4.62%,5.88%(P <0.001).After adjustmenting for age and sex and using group 3 as reference,model 1 found that HRs of non-fatal cardiovascular and cerebrovascular events(95% CIs)for group 1 to 8 were0.89(0.51-1.54),0.94(0.77-1.14),1,1.32(1.16-1.51),1.69(1.47-1.94),2.26(1.94-2.64),2.36(1.95-2.85),3.1(2.54-3.79),HRs(95% confidence interval)of all-cause death for group 1 to 8 were 0.39(0.16-0.93),1.07(0.88-1.31),1,1.19(1.04-1.37),1.31(1.12-1.52),1.3(1.09-1.56),1.71(1.39-2.1),1.89(1.51-2.37).After adjustmenting for potential confounding factors such as age,gender,triglyceride,total cholesterol,smoking,alcohol consumption and history of hypertension and diabetes,using group 3 as reference,HRs of non-fatal cardiovascular and cerebrovascular events(95% confidence interval)for group 1? group2?group 4 to 7 are 0.96(0.55-1.66),0.98(0.81-1.19),1.27(1.11-1.44),1.58(1.37-1.83),2.1(1.79-2.46),2.19(1.8-2.66),2.88(2.34-3.53).HRs(95% confidence interval)of all-cause death for group 1,group2,group 4 to 7 are0.38(0.16-0.92),1.06(0.87-1.3),1.17(1.02-1.35),1.31(1.12-1.53),1.31(1.09-1.58),1.74(1.41-2.14),1.88(1.49-2.37)respectively.Compared with PP1 group,the AR values of non-fatal cardiovascular and cerebrovascular events in Groups 2-8 were 0.000,0.003,0.020,0.067,0.193,0.256 and 0.589 respectively,AR% were-2.249%,17.282%,50.243%,68.112%,79.682%,82.117%,87.931% respectively,PAR values were 0.000,0.002,0.010,0.019,0.032,0.031,0.041 respectively,PAR% were-2.048%,16.755%,48.952%,65.968%,76.319 %,75.837%,80.598%.For all-cause mortality,AR values were 0.014,0.020,0.064,0.143,0.224,0.510,0.841 respectively,AR% were59.766%,64.679%,78.311%,84.905%,87.738%,91.693%,93.468%respectively,PAR values were 0.005,0.007,0.013,0.020,0.023,0.029,0.031 respectively,PAR% were 57.552%,63.821%,77.421%,83.618%,85.465%,88.297%,89.059% respectively.Conclusions: With the increase of blood pressure(SBP,DBP,PP),the incidence of non-fatal cardiovascular and cerebrovascular events,myocardial infarction,cerebral infarction,cerebral hemorrhage and all-cause mortality in Kailuan population increased gradually.Compared with those with normotension,the incidence of non-fatal cardiovascular and cerebrovascular events and all-cause mortality in patients with isolated systolic hypertension is high,and the incidence of non-fatal cardiovascular and cerebrovascular events of simple diastolic hypertension is high.Patients with long duration of hypertension have a high incidence of non-fatal cardiovascular andcerebrovascular events,but the duration of hypertension has nothing to do with the incidence of all-cause mortality.An increase in the SBP levels increased the risks of non-fatal cardiovascular and cerebrovascular events.When PP?45 mmHg,an increase in the PP levels increased the risks of non-fatal cardiovascular and cerebrovascular events(MI,ischemic and hemorrhagic stroke)and risk of all-cause death.Compared with elevated diastolic blood pressure,elevated systolic blood pressure leads to a higher risk of non-fatal cardiovascular and cerebrovascular events and all-cause mortality. |
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