The Time Point of Blood Pressure Measurement Rather than the Application of US vs. European Blood Pressure Categorizations Is Important for Cardiovascular Risk Prediction in Patients with the Metabolic Syndrome

This observation study (OS) recorded cardiovascular mortality over 21 years in a cohort of 1497 cardiovascular disease patients (median 65 years), of whom 680 had the metabolic syndrome (MetS). We analyzed the predictive value of blood pressure (BP) when measured at baseline of the OS or when measured in a health survey (HS) having enrolled the identical patients fifteen years prior to the OS, applying varying high BP categorizations from the US (ADA/ACC/AHA) and from Europe (EASD/ESC/ESH). Cardiovascular mortality risk increased with increasing BP categories when measured at HS but not when measured at OS (figure), irrespective of whether US or European BP categorizations were used. According to integrated discrimination improvement, the power of BP to predict cardiovascular mortality did not differ significantly between US and European categorizations (p=0.965), however, the power was significantly higher when using BP measurements at HS instead of at OS (p<0.001). This held true both among patients with the MetS (p=0.017) and also in those without the MetS (p<0.001). We conclude that earlier in life BP (HS) readings outperform BP readings done at a more advanced age (OS baseline) in terms of risk prediction for cardiovascular mortality both in MetS patients and in subjects without the MetS. Disclosure A.Leiherer: None. M.Maechler: None. B.Larcher: None. P.Fraunberger: None. G.Nagel: None. E.Zitt: None. H.Drexel: None. H.Concin: None. W.Brozek: None. A.Muendlein: None. H.Ulmer: None. C.H.Saely: None. T.Plattner: None. A.Vonbank: None. A.Mader: None. L.Sprenger: None.