Abstract
High blood pressure has been the second most important determinant of disease burden in Iran since the 1990s. Despite well-recognized evidence on the association of high blood pressure and mortality in other countries, this relationship has not been fully investigated in the demographic setting of Iran. The current study is the first large-scale longitudinal study of this association in Iran. Briefly, 50 045 subjects between 40 and 75 years of age have been recruited and followed. Blood pressure measurements were carried out at baseline. Causes of death were reported and verified by verbal autopsy throughout the follow-up period. The outcomes of interest were all-cause deaths and deaths due to ischemic heart disease (IHD) or stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). A total of 46 674 subjects free from cardiovascular disease at baseline were analyzed. Absolute mortality rates increased along with increasing systolic or diastolic blood pressure above 120 and 80 mm Hg, respectively. Adjusted HRs (95% confidence intervals) for each 20 mm Hg increase in systolic blood pressure in all age groups were 1.18 (1.13–1.23) for all-cause mortality, 1.21 (1.13–1.31) for deaths due to IHD and 1.50 (1.39–1.63) for deaths due to stroke. Unadjusted and adjusted HRs were higher in younger subjects and decreased with increasing age of the participants. High blood pressure is a serious threat to the health of Iranians. The entire health-care system of Iran should be involved in a comprehensive action plan for controlling blood pressure.
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Kannel WB, Schwartz MJ, McNamara PM . Blood pressure and risk of coronary heart disease: the Framingham study. Dis Chest 1969; 56: 43–52.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.
Lichtenstein MJ, Shipley MJ, Rose G . Systolic and diastolic blood pressures as predictors of coronary heart disease mortality in the Whitehall study. Br Med J (Clin Res Ed) 1985; 291: 243–245.
Rosenman RH, Sholtz RI, Brand RJ . A study of comparative blood pressure measures in predicting risk of coronary heart disease. Circulation 1976; 54: 51–58.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–2260.
Forouzanfar MH, Sepanlou SG, Shahraz S, Dicker D, Naghavi P, Pourmalek F et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Arch Iran Med 2014; 17: 304–320.
Naghavi M, Shahraz S, Sepanlou SG, Dicker D, Naghavi P, Pourmalek F et al. Health transition in Iran toward chronic diseases based on results of Global Burden of Disease 2010. Arch Iran Med 2014; 17: 321–335.
Egan BM, Zhao Y, Axon RN . US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303: 2043–2050.
Di Cesare M, Bennett JE, Best N, Stevens GA, Danaei G, Ezzati M . The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries. Int J Epidemiol 2013; 42: 838–848.
Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. Lancet 2011; 377: 568–577.
Pereira M, Lunet N, Azevedo A, Barros H . Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009; 27: 963–975.
Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F et al. Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health 2009; 9: 167–176.
Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens 2013; 31: 1364–1371 discussion 1371.
Hadaegh F, Shafiee G, Hatami M, Azizi F . Systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for prediction of cardiovascular events and mortality in a Middle Eastern population. Blood Press 2012; 21: 12–18.
Farzadfar F, Danaei G, Namdaritabar H, Rajaratnam JK, Marcus JR, Khosravi A et al. National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment. Popul Health Metr 2011; 9: 55–65.
Eguchi K, Yacoub M, Jhalani J, Gerin W, Schwartz JE, Pickering TG . Consistency of blood pressure differences between the left and right arms. Arch Intern Med 2007; 167: 388–393.
Pourshams A, Khademi H, Malekshah AF, Islami F, Nouraei M, Sadjadi AR et al. Cohort Profile: The Golestan Cohort Study—a prospective study of oesophageal cancer in northern Iran. Int J Epidemiol 2010; 39: 52–59.
Islami F, Kamangar F, Nasrollahzadeh D, Aghcheli K, Sotoudeh M, Abedi-Ardekani B et al. Socio-economic status and oesophageal cancer: results from a population-based case-control study in a high-risk area. Int J Epidemiol 2009; 38: 978–988.
Khademi H, Etemadi A, Kamangar F, Nouraie M, Shakeri R, Abaie B et al. Verbal autopsy: reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran. PLoS One 2010; 5: e11183.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health 2004.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Press 2014; 23: 3–16.
Madhavan S, Ooi WL, Cohen H, Alderman MH . Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension 1994; 23: 395–401.
Safar ME, Levy BI, Struijker-Boudier H . Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003; 107: 2864–2869.
Lane D, Beevers M, Barnes N, Bourne J, John A, Malins S et al. Inter-arm differences in blood pressure: when are they clinically significant? J Hypertens 2002; 20: 1089–1095.
Pastor-Barriuso R, Banegas JR, Damian J, Appel LJ, Guallar E . Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med 2003; 139: 731–739.
Aghababaei I, Sadeghi M, Talaei M, Rabiei K, Sarrafzadegan N . Is prehypertension a risk factors for cardiovascular diseases among Iranian women? J Res Med Sci 2012; 17: 947–951.
Huang Y, Su L, Cai X, Mai W, Wang S, Hu Y et al. Association of all-cause and cardiovascular mortality with prehypertension: a meta-analysis. Am Heart J 2014; 167: 160–168 e1.
Eckel RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA et al. AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 63: 2960–2984.
Mirmiran P, Hosseini-Esfahanil F, Jessri M, Mahan LK, Shiva N, Azizi F . Does dietary intake by Tehranian adults align with the 2005 dietary guidelines for Americans? Observations from the Tehran lipid and glucose study. J Health Popul Nutr 2011; 29: 39–52.
Islami F, Malekshah AF, Kimiagar M, Pourshams A, Wakefield J, Goglani G et al. Patterns of food and nutrient consumption in northern Iran, a high-risk area for esophageal cancer. Nutr Cancer 2009; 61: 475–483.
Wright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR . Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med 2014; 160: 499–503.
Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens 2014; 16: 14–26.
Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS et al. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens e-pub ahead of print 30 March 2015.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–520.
Shadpour K . Primary health care networks in the Islamic Republic of Iran. East Mediterr Health J 2000; 6: 822–825.
Acknowledgements
This study was supported in part by the intramural research program of the Division of Cancer Epidemiology and Genetics of the National Cancer Institute, NIH, by the Digestive Disease Research Institute of Tehran University of Medical Sciences (grant No 82–603), by Cancer Research UK (CRUK) and by the International Agency for Research on Cancer. We sincerely thank the Golestan Cohort study staff for their valuable helps. We also thank the study participants for their cooperation and health workers (Behvarz) in the study area for their help.
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Sepanlou, S., Sharafkhah, M., Poustchi, H. et al. Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran. J Hum Hypertens 30, 260–267 (2016). https://doi.org/10.1038/jhh.2015.57
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DOI: https://doi.org/10.1038/jhh.2015.57
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