School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China.
Graduate School of Public Health and Health Policy, City University of New York, New York, USA.
Sci Rep. 2021 Nov 8;11(1):21799. doi: 10.1038/s41598-021-00895-2.
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guidelines lowered the hypertension threshold to ≥ 130/80 mmHg, but the role of diastolic BP remains contested. This two-sample mendelian randomisation study used replicated genetic variants predicting systolic and diastolic BP applied to the UK Biobank and large genetic consortia, including of cardiovascular diseases and parental lifespan, to obtain total and direct effects. Systolic and diastolic BP had positive total effects on CVD (odds ratio (OR) per standard deviation 2.15, 95% confidence interval (CI) 1.95, 2.37 and OR 1.91, 95% CI 1.73, 2.11, respectively). Direct effects were similar for systolic BP (OR 1.83, 95% CI 1.48, 2.25) but completely attenuated for diastolic BP (1.18, 95% CI 0.97, 1.44), although diastolic BP was associated with coronary artery disease (OR 1.24, 95% CI 1.03, 1.50). Systolic and diastolic BP had similarly negative total (- 0.20 parental attained age z-score, 95% CI - 0.22, - 0.17 and - 0.17, 95% CI - 0.20, - 0.15, respectively) and direct negative effects on longevity. Our findings suggest systolic BP has larger direct effects than diastolic BP on CVD, but both have negative effects (total and direct) on longevity, supporting the 2017 ACC/AHA guidelines lowering both BP targets.
2017 年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南将高血压阈值降低至≥130/80mmHg，但舒张压的作用仍存在争议。本项两样本孟德尔随机化研究使用预测收缩压和舒张压的复制遗传变异，并应用于英国生物银行和大型遗传联盟，包括心血管疾病和父母寿命，以获得总效应和直接效应。收缩压和舒张压对 CVD 有正向的总效应（每标准差的比值比分别为 2.15，95%置信区间[CI]为 1.95，2.37 和 1.91，95%CI 为 1.73，2.11）。收缩压的直接效应相似（比值比 1.83，95%CI 为 1.48，2.25），但舒张压的直接效应完全减弱（1.18，95%CI 为 0.97，1.44），尽管舒张压与冠状动脉疾病相关（比值比 1.24，95%CI 为 1.03，1.50）。收缩压和舒张压对长寿也有类似的负向总效应（-0.20 个父母达到年龄的 Z 分数，95%CI -0.22，-0.17 和 -0.17，95%CI -0.20，-0.15）和直接负效应。我们的研究结果表明，收缩压对 CVD 的直接效应大于舒张压，但两者对长寿都有负向影响（总效应和直接效应），支持 2017 年 ACC/AHA 指南降低两个 BP 目标。
