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  • Racial/ethnic heterogeneity in associations of blood pressure and incident cardiovascular disease by functional status in a prospective cohort: the Multi-Ethnic Study of Atherosclerosis

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Epidemiology
Research
Racial/ethnic heterogeneity in associations of blood pressure and incident cardiovascular disease by functional status in a prospective cohort: the Multi-Ethnic Study of Atherosclerosis
  1. Paulina Kaiser1,
  2. Carmen A. Peralta2,
  3. Richard Kronmal3,
  4. Michael G. Shlipak2,4,
  5. Bruce M Psaty5,
  6. Michelle C Odden1
  1. 1 School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA
  2. 2 Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  3. 3 Department of Biostatistics, University of Washington, Seattle, Washington, USA
  4. 4 General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, California, USA
  5. 5 Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, andHealth Services, University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
  1. Correspondence to Dr Paulina Kaiser; paulina.kaiser{at}oregonstate.edu

Abstract

Objectives Research has demonstrated that the association between high blood pressure and outcomes is attenuated among older adults with functional limitations, compared with healthier elders. However, it is not known whether these patterns vary by racial/ethnic group. We evaluated race/ethnicity-specific patterns of effect modification in the association between blood pressure and incident cardiovascular disease (CVD) by functional status.

Setting We used data from the Multi-Ethnic Study of Atherosclerosis (2002–2004, with an average of 8.8 years of follow-up for incident CVD). We assessed effect modification of systolic blood pressure and cardiovascular outcomes by self-reported physical limitations and by age.

Participants The study included 6117 participants (aged 46 to 87; 40% white, 27% black, 22% Hispanic and 12% Chinese) who did not have CVD at the second study examination (when self-reported physical limitations were assessed).

Outcome measures Incident CVD was defined as an incident myocardial infarction, coronary revascularisation, resuscitated cardiac arrest, angina, stroke (fatal or non-fatal) or death from CVD.

Results We observed weaker associations between systolic blood pressure (SBP) and CVD among white adults with physical limitations (incident rate ratio (IRR) per 10 mm Hg higher SBP: 1.09 (95% CI 0.99 to 1.20)) than those without physical limitations (IRR 1.29 (1.19, 1.40); P value for interaction <0.01). We found a similar pattern among black adults. Poor precision among the estimates for Hispanic or Chinese participants limited the findings in these groups. The attenuated associations were consistent across both multiplicative and additive scales, though physical limitations showed clearer patterns than age on an additive scale.

Conclusion Attenuated associations between high blood pressure and incident CVD were observed for blacks and whites with poor function, though small sample sizes remain a limitation for identifying differences among Hispanic or Chinese participants. Identifying the characteristics that distinguish those in whom higher SBP is associated with less risk of morbidity or mortality may inform our understanding of the consequences of hypertension among older adults.

  • blood pressure
  • epidemiology of cardiovascular disease
  • physical function

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-017746

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    Footnotes

    • Contributors PK developed the initial research question, conducted all analyses and drafted the manuscript. MCO provided oversight, including review of analyses and editing the manuscript. CP, RK, MS and BMP reviewed the results and provided guidance on interpretation, and provided comments on multiple drafts of the manuscript.

    • Funding This research was supported by grants K01AG039387 and R01AG46206 from the National Institute on Aging; contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC- 95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01- HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from NCATS.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval IRBs at each participating site.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional unpublished data are available. More information about MESA, including all participating MESA investigators and institutions, can be found at http://www.mesa-nhlbi.org.