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(Circulation. 2000;102:307.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Two-Year Changes in Blood Pressure and Subsequent Risk of Cardiovascular Disease in Men

Howard D. Sesso, ScD, MPH; Meir J. Stampfer, MD, DrPH; Bernard Rosner, PhD; J. Michael Gaziano, MD, MPH; Charles H. Hennekens, MD, DrPH

From the Division of Preventive Medicine (H.D.S., J.M.G., C.H.H.), Cardiovascular Division (J.M.G.), and Channing Laboratory (M.J.S., B.R.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; the Departments of Epidemiology (H.D.S., M.J.S., C.H.H.) and Nutrition (M.J.S.), Harvard School of Public Health, Boston; and the Massachusetts Veterans Epidemiology Research and Information Center (J.M.G.), Veterans Affairs Medical Center, Brockton/West Roxbury, Mass. Dr Hennekens is currently a Visiting Professor of Medicine, Epidemiology, and Public Health at the University of Miami School of Medicine, Boca Raton, Fla.

Correspondence and reprint requests to Dr Howard D. Sesso, Brigham and Women’s Hospital, 900 Commonwealth Avenue East, Boston, MA 02215-1204. E-mail hsesso{at}hsph.harvard.edu

Background—It is unclear whether, given a current blood pressure level, the previous 2-year change in blood pressure adds important predictive information for cardiovascular disease (CVD).

Methods and Results—We conducted a prospective cohort study of 11 150 middle-aged and older men reporting blood pressure in the Physicians’ Health Study. These men had no history of CVD or antihypertensive medication use through the time of the 2-year follow-up questionnaire; after this time, follow-up for the current study began. A total of 905 incident cases of CVD (705 cases of coronary heart disease and 200 cases of stroke) occurred during a median follow-up of 10.8 years. After controlling for current blood pressure and other coronary risk factors, we found that previous 2-year changes in systolic blood pressure were not associated with the risk of CVD. A similar lack of association was found for individual end points of coronary heart disease and stroke. However, previous 2-year changes in diastolic blood pressure (DBP) may be inversely associated with the risk of CVD (linear trend, P=0.049) independent of coronary risk factors and current DBP. In subgroup analyses, previous 2-year blood pressure changes only added information in leaner men (body mass index <24.39 kg/m²).

Conclusions—In this normotensive population of men, the prior 2-year change in DBP, but not systolic blood pressure, may add information to current levels in relation to the risk of CVD. Clinicians may need to consider the previous pattern of DBP change when considering the risk associated with the current DBP level. These data require confirmation in other studies in which blood pressure is measured.

Key Words: blood pressure • myocardial infarction • heart diseases • epidemiology • stroke

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