Double product reflects the predictive power of systolic pressure in the general population: Evidence from 9,937 participants

Rudolph Schutte, Lutgarde Thijs, Kei Asayama, José Boggia, Yan Li, Tine W. Hansen, Yan Ping Liu, Masahiro Kikuya, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars LindEdgardo Sandoya, Kalina Kawecka-Jaszcz, Jan Filipovský, Yutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background The double product (DP), consisting of the systolic blood pressure (SBP) multiplied by the pulse rate (PR), is an index of myocardial oxygen consumption, but its prognostic value in the general population remains unknown. Methods We recorded health outcomes in 9,937 subjects (median age, 53.2 years; 47.3% women) randomly recruited from 11 populations and enrolled in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) study. We obtained the SBP, PR, and DP for these subjects as determined through 24-hour ambulatory monitoring. Results Over a median period of 11.0 years, 1,388 of the 9,937 study subjects died, of whom 536 and 794, respectively, died of cardiovascular (CV) and non-CV causes, and a further 1,161, 658, 494, and 465 subjects, respectively, experienced a CV, cardiac, coronary, or cerebrovascular event. In multivariate-adjusted Cox models, not including SBP and PR, DP predicted total, CV, and non-CV mortality (standardized hazard ratio [HR], ≥ 1.10; P ≤ 0.02), and all CV, cardiac, coronary, and stroke events (HR, ≥ 1.21; P < 0.0001). For CV mortality (HR, 1.34 vs. 1.30; P = 0.71) and coronary events (1.28 vs. 1.21; P = 0.26), SBP and the DP were equally predictive. As compared with DP, SBP was a stronger predictor of all CV events (1.39 vs. 1.27; P = 0.002) and stroke (1.61 vs. 1.36; P < 0.0001), and a slightly stronger predictor of cardiac events (1.32 vs. 1.22; P = 0.06). In fully adjusted models, including both SBP and PR, the predictive value of DP disappeared for fatal endpoints (P ≥ 0.07), coronary events (P = 0.06), and stroke (P = 0.12), or DP was even inversely associated with the risk of all CV and cardiac events (both P ≤ 0.01).CONCLUSIONIn the general population, we did not observe DP to add to risk stratification over and beyond SBP and PR.

Original languageEnglish
Pages (from-to)665-672
Number of pages8
JournalAmerican Journal of Hypertension
Volume26
Issue number5
DOIs
Publication statusPublished - 2013 May

Keywords

  • blood pressure
  • cardiovascular risk
  • double product
  • general population
  • hypertension
  • systolic blood pressure

ASJC Scopus subject areas

  • Internal Medicine

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    Schutte, R., Thijs, L., Asayama, K., Boggia, J., Li, Y., Hansen, T. W., Liu, Y. P., Kikuya, M., Björklund-Bodegård, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., ... Staessen, J. A. (2013). Double product reflects the predictive power of systolic pressure in the general population: Evidence from 9,937 participants. American Journal of Hypertension, 26(5), 665-672. https://doi.org/10.1093/ajh/hps119